Healthcare Provider Details

I. General information

NPI: 1801062237
Provider Name (Legal Business Name): STEPHEN G. MCKEEVER, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W OWEN K GARRIOTT RD BUILDING 3
ENID OK
73703-5751
US

IV. Provider business mailing address

PO BOX 10099
ENID OK
73706-0099
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 Code302F00000X
TaxonomyExclusive Provider Organization
License Number3026
License Number StateOK

VIII. Authorized Official

Name: STEPHEN G MCKEEVER
Title or Position: OWNER
Credential: DDS
Phone: 580-233-1420