Active NPI
Robert William Keba, DDS
- Dentist
- St Johnsville, NY
National Provider Identifier
1134201072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 33644
- Practice address
- 25 East Main Street
St Johnsville, NY 13452 - Phone
- (518) 568-2441
- NPI assigned
- Oct 19, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 33644 | NY | Primary |
Addresses
Primary practice location
25 East Main Street
St Johnsville, NY 13452
Mailing address
25 East Main Street PO Box 56
St Johnsville, NY 13452
Phone (518) 568-2441
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33644 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1134201072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 EAST MAIN STREET PO BOX 56",
"city": "ST JOHNSVILLE",
"state": "NY",
"postal_code": "13452",
"telephone_number": "518-568-2441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 EAST MAIN STREET",
"city": "ST JOHNSVILLE",
"state": "NY",
"postal_code": "13452",
"telephone_number": "518-568-2441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEBA",
"first_name": "ROBERT",
"middle_name": "WILLIAM",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "33644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Johnsville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.