Provider Demographics
NPI:1609182203
Name:BOYER, KEITH RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:RICHARD
Last Name:BOYER
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 1:1207 CONSTITUTION CT
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7407
Mailing Address - Country:US
Mailing Address - Phone:916-505-0791
Mailing Address - Fax:916-786-5442
Practice Address - Street 1:1217 26TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5617
Practice Address - Country:US
Practice Address - Phone:916-441-2366
Practice Address - Fax:916-441-5929
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0380661223E0200X
CA581401223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics