Provider Demographics
NPI:1396197307
Name:KECK, CHELSEA E (DDS)
Entity type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:E
Last Name:KECK
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:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0120
Mailing Address - Country:US
Mailing Address - Phone:360-748-6624
Mailing Address - Fax:360-748-4132
Practice Address - Street 1:388 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3609
Practice Address - Country:US
Practice Address - Phone:360-748-6624
Practice Address - Fax:360-748-4132
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60666702122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist