Provider Demographics
NPI:1609088418
Name:BRAM, KEITH M (DDS)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:M
Last Name:BRAM
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 1:1440 MAPLE AVE STE 3A
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4135
Mailing Address - Country:US
Mailing Address - Phone:630-963-9280
Mailing Address - Fax:630-964-6980
Practice Address - Street 1:1440 MAPLE AVE STE 3A
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4135
Practice Address - Country:US
Practice Address - Phone:630-963-9280
Practice Address - Fax:630-964-6980
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL028053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist