Provider Demographics
NPI:1871839753
Name:KEYES, GORDON D (DDS)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:D
Last Name:KEYES
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 1:751 SE BARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3278
Mailing Address - Country:US
Mailing Address - Phone:360-675-4366
Mailing Address - Fax:888-862-1244
Practice Address - Street 1:751 SE BARRINGTON DRIVE
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277
Practice Address - Country:US
Practice Address - Phone:360-675-4366
Practice Address - Fax:888-862-1244
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACORPORATE NPIOtherCORPORATE NPI