Provider Demographics
NPI:1780977405
Name:KEYES, LANCE D (DDS)
Entity type:Individual
Prefix:
First Name:LANCE D
Middle Name:
Last Name:KEYES
Suffix:
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 1:32650 STATE ROUTE 20
Mailing Address - Street 2:STE E106
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-2641
Mailing Address - Country:US
Mailing Address - Phone:360-240-9400
Mailing Address - Fax:360-675-5754
Practice Address - Street 1:32650 SR 20
Practice Address - Street 2:E106
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277
Practice Address - Country:US
Practice Address - Phone:360-240-9400
Practice Address - Fax:360-675-5754
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE606514661223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty