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General NPI Number Information
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NPI Number | 1154614758
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Entity Type | Organization
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Legal Business Name | DUONGVANNAK KEO, DMD
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 05/16/2011
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Provider Practice Location Address
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Address Line | 295 S. PLUMOSA
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City | MERRITT ISLAND
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State | FL
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Zip | 32952
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Country | US
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Telephone | 321-452-6000
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Fax | 321-453-8823
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Provider Business Mailing Address
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Address Line | 295 S. PLUMOSA
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City | MERRITT ISLAND
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State | FL
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Zip | 32952
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Country | US
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Telephone | 321-452-6000
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Fax | 321-453-8823
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Authorized Official
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Title or Position | DENTIST
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Name | DUONGVANNAK JB KEO
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Credential | D.M.D. C.A.G.S.
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Telephone | 321-452-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 19124
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 13955
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License Number State | FL
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