Provider Demographics
NPI:1861678583
Name:MATTHEW A KEIM DDS PC
Entity Type:Organization
Organization Name:MATTHEW A KEIM DDS PC
Other - Org Name:GREEN COUNTRY DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:KEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-542-1631
Mailing Address - Street 1:124 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-6325
Mailing Address - Country:US
Mailing Address - Phone:918-542-1631
Mailing Address - Fax:918-540-9141
Practice Address - Street 1:124 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6325
Practice Address - Country:US
Practice Address - Phone:918-542-1631
Practice Address - Fax:918-540-9141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty