Provider Demographics
NPI:1942463443
Name:KEITH, ANDREA JANIK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:JANIK
Last Name:KEITH
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 1:333 TOUCHDOWN DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5341
Mailing Address - Country:US
Mailing Address - Phone:214-929-6793
Mailing Address - Fax:
Practice Address - Street 1:333 TOUCHDOWN DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5341
Practice Address - Country:US
Practice Address - Phone:214-929-6793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23876OtherCHIP NUMBER