Individual
DR. KEITH RAY KONVALINKA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7070 STADIUM DR, KALAMAZOO, MI 49009-9423
(269) 375-2856
Mailing address
7070 STADIUM DR, KALAMAZOO, MI 49009-9423
(269) 375-2856
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901012870
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4062638
—
MI
Enumeration date
06/14/2005
Last updated
07/08/2007
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