Provider Demographics
NPI:1912049123
Name:KEYS, STANLEY SELWYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:SELWYN
Last Name:KEYS
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 1:8673 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2315
Mailing Address - Country:US
Mailing Address - Phone:310-275-4887
Mailing Address - Fax:
Practice Address - Street 1:8673 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2315
Practice Address - Country:US
Practice Address - Phone:310-275-4887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist