Provider Demographics
NPI:1487732913
Name:KEITH GJEBRE DMD LLC
Entity type:Organization
Organization Name:KEITH GJEBRE DMD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GJEBRE
Authorized Official - Suffix:
Authorized Official - Credentials:DMC LLC
Authorized Official - Phone:724-832-2255
Mailing Address - Street 1:510 PELLIS ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-832-2255
Mailing Address - Fax:724-832-9456
Practice Address - Street 1:510 PELLIS ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-832-2255
Practice Address - Fax:724-832-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023867L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty