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General NPI Number Information
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NPI Number | 1376672626
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Entity Type | Individual
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Provider Name | BRYAN PHILIP KEEGAN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 03/15/2016
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Provider Practice Location Address
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Address Line | 1405 MADISON PARK DR SUITE 1
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City | GLEN BURNIE
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State | MD
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Zip | 21061-5613
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Country | US
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Telephone | 410-761-7766
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Fax | 410-761-7783
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Provider Business Mailing Address
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Address Line | 8114 SANDPIPER CIR STE 211
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City | BALTIMORE
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State | MD
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Zip | 21236-5902
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Country | US
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Telephone | 410-377-2385
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 11710
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License Number State | MD
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