Provider Demographics
NPI:1023167996
Name:SPRINGE, A. KEYLA (DDS)
Entity type:Individual
Prefix:
First Name:A. KEYLA
Middle Name:
Last Name:SPRINGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANA KEYLA
Other - Middle Name:
Other - Last Name:AMARAL-SPRINGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:143 NIBLICK RD
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-4844
Mailing Address - Country:US
Mailing Address - Phone:805-226-8126
Mailing Address - Fax:
Practice Address - Street 1:143 NIBLICK RD
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-4844
Practice Address - Country:US
Practice Address - Phone:805-226-8126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA711004208OtherFEDERAL TAX ID
CA342069OtherUNITED CONCORDIA PROV ID