Provider Demographics
NPI:1720306061
Name:KEISER, SCOTT RAYMOND (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RAYMOND
Last Name:KEISER
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 1:3701 S. MAIN STREET
Mailing Address - Street 2:SUITE A150
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517
Mailing Address - Country:US
Mailing Address - Phone:859-486-2100
Mailing Address - Fax:
Practice Address - Street 1:3701 S MAIN ST
Practice Address - Street 2:SUITE A150
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-3106
Practice Address - Country:US
Practice Address - Phone:859-486-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011726A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice