Active NPI
Kelly Wayne Keith, DDS
- Dentist
- Austin, TX
National Provider Identifier
1487756250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 14077
- Practice address
- 3800 Speedway
Austin, TX 78751 - Phone
- (512) 452-6405
- Fax
- (512) 452-7365
- NPI assigned
- Sep 2, 2006
- 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 | 14077 | TX | Primary |
Addresses
Primary practice location
3800 Speedway
Austin, TX 78751
Mailing address
4201 North Hills Dr
Austin, TX 78731
Phone (512) 342-9697
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 |
|---|---|---|---|
| 14077 | TX | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487756250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 NORTH HILLS DR",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78731",
"telephone_number": "512-342-9697",
"fax_number": "512-452-7365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3800 SPEEDWAY",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78751",
"telephone_number": "512-452-6405",
"fax_number": "512-452-7365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEITH",
"first_name": "KELLY",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "14077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
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.