MEDICARE: DR. RONIQUE KEANE-DAWES DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN014007	GA

General Provider Information

NPI Number	:	1457688004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONIQUE KEANE-DAWES DDS

Provider Business Mailing Address
First Line	:	1386 GRAY HWY
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31211-1952
Country	:	US
Telephone Number	:	478-745-5239
Fax Number	:	478-745-5248

Provider Business Practice Location Address
First Line	:	400 GALLERIA PKWY SE
Second Line	:	SUITE 800
City	:	ATLANTA
State	:	GA
Zip	:	30339-5980
Country	:	US
Telephone Number	:	678-904-5665
Fax Number	:	678-904-5666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	11/03/2009

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