Individual
KEATON FORRESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
375 MDG 310 WEST LOSEY, SCOTT AFB, IL 62225-5252
(618) 256-6667
Mailing address
375 MDG 310 WEST LOSEY, SCOTT AFB, IL 62225-5252
(618) 256-6667
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
8569
SC
1223P0700X
Prosthodontics
Primary
8569
SC
Other
Enumeration date
04/13/2016
Last updated
09/12/2018
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