Gary Demetrick Keeler, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

3478 Issued in MS

Practice address

1053 Hunters Crossing Dr.
Alcoa, TN 37701

Phone

(865) 223-6705

NPI assigned

Nov 15, 2007

Last updated

Apr 28, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gary Keeler DDS, Oral Maxillofacial Surgery LLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Flowood, MS
  • NPI 1659626448
  NPD Authorized official
• Maryville Modern Dentistry, PC

  dba Maryville Modern Dentistry

  • Dentist
  • Alcoa, TN
  • NPI 1679056683
  NPD (past)
• Northshore Smiles Dentistry, PC

  dba Northshore Smiles Dentistry

  • Dentist
  • Knoxville, TN
  • NPI 1477057933
  NPD (past)

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777334400000",
    "number": "1285815589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 E COUNTY LINE RD STE 3A-213",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391571900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1053 HUNTERS CROSSING DR.",
            "city": "ALCOA",
            "state": "TN",
            "postal_code": "37701",
            "telephone_number": "865-223-6705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2020 Town Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Knoxville",
            "state": "TN",
            "postal_code": "379226677",
            "country_code": "US",
            "telephone_number": "865-233-6517",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3802 Paxton Ave",
            "address_2": "Ste 12",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "45209",
            "country_code": "US",
            "telephone_number": "513-898-1194",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEELER",
        "first_name": "GARY",
        "middle_name": "DEMETRICK",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-15",
        "last_updated": "2026-04-28",
        "certification_date": "2026-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "8114",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "30.028230",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MS",
            "license": "3478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01880393",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Alcoa, TN
• Providers in Alcoa, TN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.