Provider Demographics
NPI:1770798548
Name:KEITH, ELIZABETH HERNANDEZ (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HERNANDEZ
Last Name:KEITH
Suffix:
Gender:F
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:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-1038
Mailing Address - Country:US
Mailing Address - Phone:828-264-3333
Mailing Address - Fax:828-264-6340
Practice Address - Street 1:870 STATE FARM RD STE 103A
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4862
Practice Address - Country:US
Practice Address - Phone:828-264-3333
Practice Address - Fax:828-264-6340
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice