MEDICARE: DR. STEPHEN MICHAEL KEEL D.M.D

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	122300000X	Dentist	3745-14	MS

General Provider Information

NPI Number	:	1619380458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN MICHAEL KEEL D.M.D

Provider Business Mailing Address
First Line	:	20040 PINEVILLE RD
Second Line	:
City	:	LONG BEACH
State	:	MS
Zip	:	39560-3352
Country	:	US
Telephone Number	:	228-868-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	20040 PINEVILLE RD
Second Line	:
City	:	LONG BEACH
State	:	MS
Zip	:	39560-3352
Country	:	US
Telephone Number	:	228-868-2828
Fax Number	:

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

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	03/11/2020

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