Provider Demographics
NPI:1457375776
Name:R KEITH DEDMOND DDS PA
Entity Type:Organization
Organization Name:R KEITH DEDMOND DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:DEDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:704-735-7001
Mailing Address - Street 1:301 S ACADEMY STREET
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092
Mailing Address - Country:US
Mailing Address - Phone:704-735-7001
Mailing Address - Fax:704-735-7654
Practice Address - Street 1:301 S ACADEMY STREET
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092
Practice Address - Country:US
Practice Address - Phone:704-735-7001
Practice Address - Fax:704-735-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty