Provider Demographics
NPI:1972607166
Name:KAPPES, KEITH ANDREW (DDS)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ANDREW
Last Name:KAPPES
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 1:1100 W GONZALES RD STE 106
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-3375
Mailing Address - Country:US
Mailing Address - Phone:805-278-1650
Mailing Address - Fax:805-278-1640
Practice Address - Street 1:1100 W GONZALES RD
Practice Address - Street 2:SUITE 106
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-3375
Practice Address - Country:US
Practice Address - Phone:805-278-1650
Practice Address - Fax:805-278-1640
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice