Provider Demographics
NPI:1881911063
Name:VIBERT, KEITH JERRY (DDS)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JERRY
Last Name:VIBERT
Suffix:
Gender:M
Credentials:DDS
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Other - Credentials:
Mailing Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Mailing Address - Street 2:MEDICAL STAFF OFFICE T9
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-7097
Mailing Address - Country:US
Mailing Address - Phone:631-444-2754
Mailing Address - Fax:631-444-6031
Practice Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Practice Address - Street 2:MEDICAL STAFF OFFICE T9
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-7097
Practice Address - Country:US
Practice Address - Phone:631-444-2754
Practice Address - Fax:631-444-6031
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2023-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY055638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist