Provider Demographics
NPI:1346380565
Name:KEITH, PRESTON WYLIE (DDS)
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:WYLIE
Last Name:KEITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 BATTLEGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2631
Mailing Address - Country:US
Mailing Address - Phone:336-288-1242
Mailing Address - Fax:336-288-2860
Practice Address - Street 1:3131 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2631
Practice Address - Country:US
Practice Address - Phone:336-288-1242
Practice Address - Fax:336-288-2860
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice