Provider Demographics
NPI:1750454963
Name:KEITH, ALLAN PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:PATRICK
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:PO BOX 584
Mailing Address - Street 2:2184 LOCUST ST
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614
Mailing Address - Country:US
Mailing Address - Phone:330-854-5152
Mailing Address - Fax:330-854-5100
Practice Address - Street 1:2184 LOCUST ST
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614
Practice Address - Country:US
Practice Address - Phone:330-854-5152
Practice Address - Fax:330-854-5100
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH198311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice