Provider Demographics
NPI:1467585802
Name:YOUNT, KEITH A (DDS, MAGD, ABOP)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:YOUNT
Suffix:
Gender:M
Credentials:DDS, MAGD, ABOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 LAKE BOONE TRL STE 107
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7511
Mailing Address - Country:US
Mailing Address - Phone:919-781-6600
Mailing Address - Fax:919-781-6430
Practice Address - Street 1:4201 LAKE BOONE TRL STE 107
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7511
Practice Address - Country:US
Practice Address - Phone:919-781-6600
Practice Address - Fax:919-781-6430
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC47011223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU90243Medicare UPIN