Provider Demographics
NPI:1285937771
Name:PACKER, KEITH (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:PACKER
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8151 E INDIAN BEND RD
Mailing Address - Street 2:STE 111
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4826
Mailing Address - Country:US
Mailing Address - Phone:480-607-9999
Mailing Address - Fax:
Practice Address - Street 1:1502 N ZARAGOZA RD
Practice Address - Street 2:SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7905
Practice Address - Country:US
Practice Address - Phone:915-855-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics