Provider Demographics
NPI:1477654259
Name:KEETHLER, KENT ALLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:ALLAN
Last Name:KEETHLER
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 1:1806 WEST 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2420
Mailing Address - Country:US
Mailing Address - Phone:660-826-0146
Mailing Address - Fax:660-827-4719
Practice Address - Street 1:1806 WEST 5TH STREET
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2420
Practice Address - Country:US
Practice Address - Phone:660-826-0146
Practice Address - Fax:660-827-4719
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO014457122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist