Organization
KEITH W. STREET DMD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH WILLIAM STREET DMD (ORTHODONTIST)
(864) 224-2526
Entity
Organization
Contact information
Practice address
110 BUFORD AVE, ANDERSON, SC 29621-3314
(864) 224-2526
Mailing address
110 BUFORD AVE, ANDERSON, SC 29621-3314
(864) 224-2526
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2894 SPEC 0391
SC
Other
Enumeration date
09/23/2008
Last updated
09/23/2008
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