Provider Demographics
NPI:1619550951
Name:KEITH, PETER JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAMES
Last Name:KEITH
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 1:6618 SW WENTLEY LN
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4400
Mailing Address - Country:US
Mailing Address - Phone:714-391-4126
Mailing Address - Fax:
Practice Address - Street 1:6618 SW WENTLEY LN
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4400
Practice Address - Country:US
Practice Address - Phone:714-391-4126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002030301223G0001X
OK63981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice