Keith Felix Theodore, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7399 Issued in MD

Practice address

16729 Queen Anne Rd
Upper Marlboro, MD 20774-8754

Phone

(301) 613-2430

NPI assigned

Nov 26, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1290729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290729600000",
    "number": "1902108897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16729 QUEEN ANNE RD",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207748754",
            "telephone_number": "301-613-2430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16729 QUEEN ANNE RD",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207748754",
            "telephone_number": "301-613-2430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEODORE",
        "first_name": "KEITH",
        "middle_name": "FELIX",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-26",
        "last_updated": "2010-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "7399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164519385",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Upper Marlboro, MD
• Providers in Upper Marlboro, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2010; 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.