Provider Demographics
NPI:1528419041
Name:KEEFFER, MATTHEW (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KEEFFER
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 1:1435 S 1350 E
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1300
Mailing Address - Country:US
Mailing Address - Phone:801-773-6170
Mailing Address - Fax:801-773-3371
Practice Address - Street 1:1435 S 1350 E
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1300
Practice Address - Country:US
Practice Address - Phone:801-773-6170
Practice Address - Fax:801-773-3371
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5925613-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist