Provider Demographics
NPI:1275011165
Name:KEITH, ANDREW JACOB (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JACOB
Last Name:KEITH
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4142
Mailing Address - Country:US
Mailing Address - Phone:425-466-8544
Mailing Address - Fax:
Practice Address - Street 1:3645 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4142
Practice Address - Country:US
Practice Address - Phone:619-291-2980
Practice Address - Fax:619-291-2984
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA608644531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice