Healthcare Provider Details

I. General information

NPI: 1326352295
Provider Name (Legal Business Name): JOSEPH WILLIAM KECK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E BOW ST
THORNTOWN IN
46071-1164
US

IV. Provider business mailing address

151 E BOW ST
THORNTOWN IN
46071-1164
US

V. Phone/Fax

Practice location:
  • Phone: 765-436-2433
  • Fax: 765-436-2551
Mailing address:
  • Phone: 765-436-2433
  • Fax: 765-436-2551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12011437A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: