Individual
DR. KELLY WAYNE KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3800 SPEEDWAY, AUSTIN, TX 78751
(512) 452-6405
(512) 452-7365
Mailing address
4201 NORTH HILLS DR, AUSTIN, TX 78731
(512) 342-9697
(512) 452-7365
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14077
TX
Other
Enumeration date
09/02/2006
Last updated
07/08/2007
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