Provider Demographics
NPI:1750637575
Name:KEELER, ALEXANDRA NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:KEELER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E RICHARDS ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-2970
Mailing Address - Country:US
Mailing Address - Phone:307-358-1720
Mailing Address - Fax:307-358-1969
Practice Address - Street 1:1010 E RICHARDS ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-2970
Practice Address - Country:US
Practice Address - Phone:307-358-1720
Practice Address - Fax:307-358-1969
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice