Provider Demographics
NPI:1285761742
Name:SOLIDAY, KEITH TYLER (DDS (ORAL SURGEON))
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:TYLER
Last Name:SOLIDAY
Suffix:
Gender:M
Credentials:DDS (ORAL SURGEON)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 BUFORD AVE
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325
Mailing Address - Country:US
Mailing Address - Phone:717-337-9377
Mailing Address - Fax:717-337-3883
Practice Address - Street 1:228 BUFORD AVE
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325
Practice Address - Country:US
Practice Address - Phone:717-337-9377
Practice Address - Fax:717-337-3883
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028948L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
S0709498Medicare PIN
PASO709498Medicare ID - Type Unspecified
PAU56274Medicare UPIN