Provider Demographics
NPI:1346227303
Name:MERCHANT, KEITH ROSHANALI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ROSHANALI
Last Name:MERCHANT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 YOSEMITE DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3610
Mailing Address - Country:US
Mailing Address - Phone:619-941-1266
Mailing Address - Fax:
Practice Address - Street 1:1879 PLATTE RIVER LN
Practice Address - Street 2:#2
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1698
Practice Address - Country:US
Practice Address - Phone:619-941-1266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA54891223G0001X
CA557941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice