Provider Demographics
NPI:1689740490
Name:KEITH G KANTER DDS PA
Entity Type:Organization
Organization Name:KEITH G KANTER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:G
Authorized Official - Last Name:KANTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-851-2996
Mailing Address - Street 1:4861 SOUTH ORANGE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:407-851-2996
Mailing Address - Fax:407-851-3025
Practice Address - Street 1:4861 SOUTH ORANGE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-851-2996
Practice Address - Fax:407-851-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0072771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A13637Medicare UPIN