Provider Demographics
NPI:1306802285
Name:STILLWELL, KEITH DAVID (DDS, MAGD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:DAVID
Last Name:STILLWELL
Suffix:
Gender:M
Credentials:DDS, MAGD
Other - Prefix:DR
Other - First Name:K.
Other - Middle Name:DAVID
Other - Last Name:STILLWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MAGD
Mailing Address - Street 1:4301 W. MARKHAM STREET
Mailing Address - Street 2:SLOT 624
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7199
Mailing Address - Country:US
Mailing Address - Phone:501-686-8086
Mailing Address - Fax:501-686-6855
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:SLOT 624
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-8086
Practice Address - Fax:501-686-6855
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3210122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3210OtherDENTAL LICENSE
ARFS0664676OtherDEA