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General NPI Number Information
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NPI Number | 1568728269
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Entity Type | Organization
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Legal Business Name | KEENE FAMILY DENTAL, PA
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Dates
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Enumeration Date | 04/06/2012
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Last Update Date | 04/06/2012
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Provider Practice Location Address
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Address Line | 428 S OLD BETSY RD STE. C
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City | KEENE
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State | TX
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Zip | 76059-1411
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Country | US
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Telephone | 817-641-0000
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Fax | 817-556-6291
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Provider Business Mailing Address
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Address Line | 1801 PRECINCT LINE RD STE. A
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City | HURST
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State | TX
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Zip | 76054-3170
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Country | US
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Telephone | 817-577-9200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAIVAN KEVIN AFKAMI
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Credential | DDS
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Telephone | 817-577-9200
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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 | 20467
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License Number State | TX
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