Provider Demographics
NPI:1972793339
Name:R. KEITH CALVERT, DMD PC
Entity Type:Organization
Organization Name:R. KEITH CALVERT, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-836-0877
Mailing Address - Street 1:313 AARON DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-8201
Mailing Address - Country:US
Mailing Address - Phone:205-836-0877
Mailing Address - Fax:205-836-5751
Practice Address - Street 1:313 AARON DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-8201
Practice Address - Country:US
Practice Address - Phone:205-836-0877
Practice Address - Fax:205-836-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2703261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental