Konvalinka, Keith Ray
Konvalinka, Keith Ray is an individual health care provider with primary practice located at 7070 Stadium Dr , Kalamazoo MI 49009-9423. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Konvalinka, Keith Ray can be contacted via phone (269) 375-2856.Contact Information
Primary practice address
7070 Stadium Dr
Kalamazoo MI 49009-9423
Phone: (269) 375-2856
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 2901012870 | Michigan |
Profile Details
| NPI number | 1275538662 |
|---|---|
| LBN Legal business name | Konvalinka, Keith Ray |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 14th, 2005 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275538662 | NPPES |
| Michigan | MEDICAID | 4062638 |
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