Individual
KEITH BRIAN DOUTS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6920 INDIANAPOLIS BLVD, HAMMOND, IN 46324-2206
(219) 763-8112
(219) 844-9006
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-3251
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12011663A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201032760
—
IN
Enumeration date
07/18/2011
Last updated
01/04/2017
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