Provider Demographics
NPI:1437179397
Name:KEITH, CHRISTINE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:A
Last Name:KEITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:A
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7100 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2714
Mailing Address - Country:US
Mailing Address - Phone:402-506-9127
Mailing Address - Fax:402-315-2707
Practice Address - Street 1:7100 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2714
Practice Address - Country:US
Practice Address - Phone:402-506-9127
Practice Address - Fax:402-315-2707
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE61631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice