Provider Demographics
NPI:1407867195
Name:KIEFER, KEITH SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:SCOTT
Last Name:KIEFER
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 1:70 GAUL RD
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-9600
Mailing Address - Country:US
Mailing Address - Phone:610-678-0367
Mailing Address - Fax:
Practice Address - Street 1:2729 N 11TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-2731
Practice Address - Country:US
Practice Address - Phone:610-921-3566
Practice Address - Fax:610-939-9698
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026803L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice