Provider Demographics
NPI:1306482104
Name:KEITH R.R. GAUGHT, DDS, PA
Entity type:Organization
Organization Name:KEITH R.R. GAUGHT, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:RICHARD REUBEN
Authorized Official - Last Name:GAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-847-6453
Mailing Address - Street 1:101 HEDWIG CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8693
Mailing Address - Country:US
Mailing Address - Phone:219-916-6119
Mailing Address - Fax:
Practice Address - Street 1:7718 SIX FORKS ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5072
Practice Address - Country:US
Practice Address - Phone:919-847-6453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty