Provider Demographics
NPI:1740368273
Name:GJEBRE, KEITH (DMD LLC)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:GJEBRE
Suffix:
Gender:M
Credentials:DMD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 PELLIS ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-832-2255
Mailing Address - Fax:724-832-9456
Practice Address - Street 1:510 PELLIS ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-832-2255
Practice Address - Fax:724-832-9456
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS023867L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry