Provider Demographics
NPI:1366460743
Name:STRAUSBAUGH, KEITH WILSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:WILSON
Last Name:STRAUSBAUGH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2411
Mailing Address - Country:US
Mailing Address - Phone:864-233-1905
Mailing Address - Fax:864-232-5918
Practice Address - Street 1:1525 CLEVELAND ST.
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2411
Practice Address - Country:US
Practice Address - Phone:864-233-1905
Practice Address - Fax:864-232-5918
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice