Healthcare Provider Details

I. General information

NPI: 1780686253
Provider Name (Legal Business Name): STEPHEN RICHARD KEES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 GRANDVIEW DR
FT MITCHELL KY
41017-1633
US

IV. Provider business mailing address

2370 GRANDVIEW DR
FT MITCHELL KY
41017-1633
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-4449
  • Fax: 859-331-4474
Mailing address:
  • Phone: 859-331-4449
  • Fax: 859-331-4474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number05319
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: