Provider Demographics
NPI:1225579386
Name:KEITH, THOMAS (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:KEITH
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 1:200 HAWKINS DRIVE
Mailing Address - Street 2:ORAL AND MAXILLOFACIAL SURGERY
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242
Mailing Address - Country:US
Mailing Address - Phone:319-356-7339
Mailing Address - Fax:319-353-6923
Practice Address - Street 1:200 HAWKINS DRIVE
Practice Address - Street 2:ORAL AND MAXILLOFACIAL SURGERY
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240
Practice Address - Country:US
Practice Address - Phone:319-356-7339
Practice Address - Fax:319-353-6923
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program