Keith F. Theodore, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

7399 Issued in MD

Legal business name

KEITH F. THEODORE, DDS

Practice address

9510 Lanham Severn Rd
Lanham, MD 20706-2624

Phone

(301) 577-6002

Fax

(301) 577-7267

NPI assigned

Oct 8, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Keith Felix Theodore, DDS

Title

President

Phone

(301) 577-6002

Specialties & licenses 1

Addresses

Other names 1

• (1)LANHAM FAMILY DENTAL CENTER (2)TOOTH-N-NAIL,INC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164519385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9510 LANHAM SEVERN RD",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207062624",
            "telephone_number": "301-577-6002",
            "fax_number": "301-577-7267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9510 LANHAM SEVERN RD",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207062624",
            "telephone_number": "301-577-6002",
            "fax_number": "301-577-7267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH F. THEODORE, DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THEODORE",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "FELIX",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-577-6002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MD",
            "license": "7399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "(1)LANHAM FAMILY DENTAL CENTER (2)TOOTH-N-NAIL,INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.