Provider Demographics
NPI:1760509434
Name:KITCHENS, KEITH EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:EDWARD
Last Name:KITCHENS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12850 HIGHWAY 9 N
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4231
Mailing Address - Country:US
Mailing Address - Phone:770-569-7580
Mailing Address - Fax:770-569-4119
Practice Address - Street 1:12850 HIGHWAY 9 N
Practice Address - Street 2:SUITE 1400
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-4231
Practice Address - Country:US
Practice Address - Phone:770-569-7580
Practice Address - Fax:770-569-4119
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0111591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice