Provider Demographics
NPI:1124297510
Name:KEISER, CONNIE (RDH)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:KEISER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2290
Mailing Address - Country:US
Mailing Address - Phone:719-589-5161
Mailing Address - Fax:719-589-5722
Practice Address - Street 1:220 S WORTH STREET
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:CO
Practice Address - Zip Code:81125
Practice Address - Country:US
Practice Address - Phone:719-754-3584
Practice Address - Fax:719-754-2470
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO904401124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist