Healthcare Provider Details

I. General information

NPI: 1144309097
Provider Name (Legal Business Name): PAMELA KEANE R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15182 N 75TH AVE STE 120
PEORIA AZ
85381-4722
US

IV. Provider business mailing address

2610 W VIA DE PEDRO MIGUEL
PHOENIX AZ
85086-6643
US

V. Phone/Fax

Practice location:
  • Phone: 623-878-2400
  • Fax:
Mailing address:
  • Phone: 623-535-4664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH4227
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: