Most Relevant Information
Provider Data
| NPI Number: | 1003381914 |
| Provider Name: | KEYAN BOTSFORD DMD, MSD |
| Entity Type: | Individual |
| Taxonomy Code: | 1223X0400X |
| Specialty: | Dentist |
| License Number: | D10917 |
Most Important Dates
| Enumeration Date: | 10/06/2018 |
| Last Updated: | 08/14/2019 |
Provider Practice Location
1625 E MCANDREWS RD STE B
MEDFORD
OR
975045334
Practice Location Phone/Fax
| Phone: | 5417793003 |
| Fax: |
Provider Mailing Location
1625 E MCANDREWS RD STE B
MEDFORD
OR
975045334
Provider Mailing Phone/Fax
| Phone: | 5417793003 |
| Fax: |