Provider Demographics
NPI:1407410285
Name:KEYER, DENAE CHEYENNE (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:DENAE
Middle Name:CHEYENNE
Last Name:KEYER
Suffix:
Gender:F
Credentials:DMD, MD
Other - Prefix:
Other - First Name:DENAE
Other - Middle Name:CHEYENNE
Other - Last Name:BRITSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DENAE C RUSHING
Mailing Address - Street 1:506 SAINT ALBANS RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5605
Mailing Address - Country:US
Mailing Address - Phone:210-247-7019
Mailing Address - Fax:
Practice Address - Street 1:2301 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4427
Practice Address - Country:US
Practice Address - Phone:267-367-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS043940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program