Provider Demographics
NPI:1710141783
Name:TAM, KEITH H (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:H
Last Name:TAM
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 1:570 E BETTERAVIA RD STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8851
Mailing Address - Country:US
Mailing Address - Phone:805-922-2888
Mailing Address - Fax:
Practice Address - Street 1:570 E BETTERAVIA RD STE C
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8851
Practice Address - Country:US
Practice Address - Phone:805-922-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18550311223P0221X
CA572931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry