Healthcare Provider Details

I. General information

NPI: 1891787461
Provider Name (Legal Business Name): STEPHEN G MCKEEVER DDS, MAGD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W GARRIOTT RD
ENID OK
73703-5751
US

IV. Provider business mailing address

1420 W GARRIOTT RD
ENID OK
73703-5751
US

V. Phone/Fax

Practice location:
  • Phone: 580-233-1420
  • Fax: 580-233-2908
Mailing address:
  • Phone: 580-233-1420
  • Fax: 580-233-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3026
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: