Provider Demographics
NPI:1669768107
Name:KEYS, KEVIN GENTRY (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GENTRY
Last Name:KEYS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 AVENUE G NW
Mailing Address - Street 2:STE. A
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-3310
Mailing Address - Country:US
Mailing Address - Phone:940-937-0800
Mailing Address - Fax:940-937-0803
Practice Address - Street 1:1900 AVENUE G NW
Practice Address - Street 2:STE. A
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-3310
Practice Address - Country:US
Practice Address - Phone:940-937-0800
Practice Address - Fax:940-937-0803
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice