Provider Demographics
NPI:1649256108
Name:KEITH, JAMES ALVIN JR (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALVIN
Last Name:KEITH
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11770 HAYNES BRIDGE RD
Mailing Address - Street 2:605
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1966
Mailing Address - Country:US
Mailing Address - Phone:678-689-0025
Mailing Address - Fax:
Practice Address - Street 1:11770 HAYNES BRIDGE RD
Practice Address - Street 2:605
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1966
Practice Address - Country:US
Practice Address - Phone:678-689-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410916122300000X
GADN014194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist