Provider Demographics
NPI:1184715799
Name:SCHLOSS, KEITH CHARLES (DMD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:CHARLES
Last Name:SCHLOSS
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 1:5704 JONES LN
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-1126
Mailing Address - Country:US
Mailing Address - Phone:814-838-2458
Mailing Address - Fax:
Practice Address - Street 1:4020 STERRETTANIA RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4125
Practice Address - Country:US
Practice Address - Phone:814-835-3740
Practice Address - Fax:814-835-5233
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023531L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice