Individual
KEITH OULIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
146 BROWN RD, CUMBERLAND, VA 23040-2119
(804) 492-4812
Mailing address
PO BOX 51, CUMBERLAND, VA 23040-0051
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401004351
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401004351
VIRGINIA DENTAL LICENSE
VA
Enumeration date
02/23/2014
Last updated
02/23/2014
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