Provider Demographics
NPI:1942349576
Name:KEILTY, SCOTT MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:KEILTY
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 1:20 S ANGUILLA RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-1447
Mailing Address - Country:US
Mailing Address - Phone:860-599-2505
Mailing Address - Fax:
Practice Address - Street 1:20 S ANGUILLA RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-1447
Practice Address - Country:US
Practice Address - Phone:860-599-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT75001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice