MEDICARE: KEENAN OSMAN DMD

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	DN24476	FL

General Provider Information

NPI Number	:	1508413105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEENAN OSMAN DMD

Provider Business Mailing Address
First Line	:	4744 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2181
Country	:	US
Telephone Number	:	863-644-1226
Fax Number	:

Provider Business Practice Location Address
First Line	:	15511 N FLORIDA AVE STE 501
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-1215
Country	:	US
Telephone Number	:	813-223-5677
Fax Number	:

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

Provider Enumeration Date	:	08/20/2019
Last Update Date	:	12/11/2024

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