Provider Demographics
NPI:1801047725
Name:KEYS FAMILY DENTISTRY
Entity type:Organization
Organization Name:KEYS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SNELL
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-458-5140
Mailing Address - Street 1:26245 HIGHWAY 82
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PARK HILL
Mailing Address - State:OK
Mailing Address - Zip Code:74451-3802
Mailing Address - Country:US
Mailing Address - Phone:918-458-5140
Mailing Address - Fax:918-458-5155
Practice Address - Street 1:26245 HIGHWAY 82
Practice Address - Street 2:SUITE 2
Practice Address - City:PARK HILL
Practice Address - State:OK
Practice Address - Zip Code:74451-3802
Practice Address - Country:US
Practice Address - Phone:918-458-5140
Practice Address - Fax:918-458-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200039590AMedicaid