Organization
KEITH DOTY DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH W DOTY DDS (OWNER/DENTIST)
(503) 620-5313
Entity
Organization
Contact information
Practice address
12540 SW 68TH AVE, SUITE A, TIGARD, OR 97223-8597
(503) 620-5313
(503) 620-5497
Mailing address
12540 SW 68TH AVE, SUITE A, TIGARD, OR 97223-8597
(503) 620-5313
(503) 620-5497
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6165
OR
Other
Enumeration date
11/22/2010
Last updated
11/22/2010
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