Provider Demographics
NPI:1588683171
Name:KEYSER, JENNIFER DARLENE (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DARLENE
Last Name:KEYSER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 LANIER AVE W STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1833
Mailing Address - Country:US
Mailing Address - Phone:770-692-0453
Mailing Address - Fax:
Practice Address - Street 1:600 LANIER AVE W STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1833
Practice Address - Country:US
Practice Address - Phone:770-692-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0351401223S0112X
GADN0153451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001615861OtherHIGHMARK BCBS
PAP00252465OtherMEDICARE RAILROAD
PA410390OtherUPMC HEALTH PLAN
PA86957OtherGEISINGER HEALTH PLAN
PA101115006Medicaid
PA101115006Medicaid
PA86957OtherGEISINGER HEALTH PLAN