Keithline Digital Imaging LLC

Primary specialty

Oral and Maxillofacial Radiology DentistryTaxonomy code 1223X0008X

License

784 Issued in OK

Legal business name

KEITHLINE DIGITAL IMAGING LLC

Practice address

1421 E 13TH St
Tulsa, OK 74120-5207

Phone

(918) 585-3744

Fax

(918) 585-3774

NPI assigned

Jun 30, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Charles R Keithline III, DDS

Title

Owner

Phone

(918) 585-3744

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Utica Imaging Doing business as

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

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246320000000",
    "number": "1467680231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 E 13TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741205207",
            "telephone_number": "918-585-3744",
            "fax_number": "918-585-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 E 13TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741205207",
            "telephone_number": "918-585-3744",
            "fax_number": "918-585-3774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITHLINE DIGITAL IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-30",
        "last_updated": "2009-06-30",
        "status": "A",
        "authorized_official_last_name": "KEITHLINE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-585-3744",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0008X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Radiology",
            "state": "OK",
            "license": "784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100635530C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Utica Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Callie Keith, MS
• Hadley Keith
• Melissa Keith
• Rylee Keith
• Sandra Kay Keith, MPH R.D. L.D.
• Charles R. Keithline, DDS
• Krystel Yaya Kekay Epse Ekiti Martin, MD
• Aaron J Kelkhoff, MD
• Elizabeth Ann Keller-Dupree, PH.D.
• Alan Marvin Keller, M.D.

• Dentist in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Dentist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2009; 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.