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General NPI Number Information
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NPI Number | 1376947259
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Entity Type | Organization
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Legal Business Name | KEITH A. MEHNER, D.D.S.,P.L.L.C
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Dates
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Enumeration Date | 10/21/2014
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 403 W. BROADWAY AVE
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City | MCLOUD
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State | OK
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Zip | 74851-8266
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Country | US
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Telephone | 405-964-2500
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Fax | 405-964-2515
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Provider Business Mailing Address
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Address Line | 403 W. BROADWAY AVE
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City | MCLOUD
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State | OK
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Zip | 74851-8266
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Country | US
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Telephone | 405-964-2500
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Fax | 405-964-2515
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Authorized Official
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Title or Position | OWNER
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Name | KEITH A MEHNER
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Credential | DDS
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Telephone | 405-964-2500
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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 | 6201
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License Number State | OK
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