Provider Demographics
NPI:1740560549
Name:KEYSTONE DENTAL, PLLC
Entity Type:Organization
Organization Name:KEYSTONE DENTAL, PLLC
Other - Org Name:SMILE TODAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUISH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-994-9494
Mailing Address - Street 1:8040 EAST INDIAN SCHOOL ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-994-9494
Mailing Address - Fax:480-949-8395
Practice Address - Street 1:8040 E INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-2685
Practice Address - Country:US
Practice Address - Phone:480-994-9494
Practice Address - Fax:480-949-8395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8070261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental