Provider Demographics
NPI:1598865073
Name:KEEVER, CHARLES HOBART III (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HOBART
Last Name:KEEVER
Suffix:III
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 1:1221 E SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1811
Mailing Address - Country:US
Mailing Address - Phone:231-739-5105
Mailing Address - Fax:231-739-7432
Practice Address - Street 1:1221 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1811
Practice Address - Country:US
Practice Address - Phone:231-739-5105
Practice Address - Fax:231-739-7432
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist