Individual
DR. KEITH EARL JANUARY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, DMD
Contact information
Practice address
314 N FRANKLIN ST, BASTROP, LA 71220-3846
(318) 283-8887
(318) 281-6339
Mailing address
PO BOX 792, BASTROP, LA 71221-0792
(318) 283-8887
(318) 281-2559
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7359
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1873594
—
LA
Enumeration date
04/21/2022
Last updated
03/20/2025
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