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General NPI Number Information
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NPI Number | 1407027402
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Entity Type | Organization
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Legal Business Name | CARLA M. KEENE, D.D.S.
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 15189 PORTERFIELD HIGHWAY
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City | ABINGDON
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State | VA
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Zip | 24211
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Country | US
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Telephone | 276-676-0070
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Fax | 276-676-0880
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Provider Business Mailing Address
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Address Line | PO BOX 287
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City | ABINGDON
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State | VA
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Zip | 24212-0287
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Country | US
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Telephone | 276-676-0070
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Fax | 276-676-0880
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Authorized Official
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Title or Position | DENTAL PRACTITIONER
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Name | DR. CARLA MARIE KEENE
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Credential | D.D.S.
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Telephone | 276-676-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401007589
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License Number State | VA
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