Provider Demographics
NPI:1598894438
Name:KEITH, SCOTT EDWARD (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDWARD
Last Name:KEITH
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:1111 CIVIC DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3895
Mailing Address - Country:US
Mailing Address - Phone:925-935-4040
Mailing Address - Fax:925-935-4077
Practice Address - Street 1:1111 CIVIC DR
Practice Address - Street 2:SUITE 320
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3895
Practice Address - Country:US
Practice Address - Phone:925-935-4040
Practice Address - Fax:925-935-4077
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA429231223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics