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General NPI Number Information
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NPI Number | 1649638214
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Entity Type | Organization
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Legal Business Name | KEELAN DENTAL
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 02/10/2016
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Provider Practice Location Address
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Address Line | 1022 N MAIN STREET EXT
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City | BUTLER
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State | PA
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Zip | 16001-1956
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Country | US
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Telephone | 724-285-4153
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Fax |
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Provider Business Mailing Address
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Address Line | 1022 N MAIN STREET EXT AVADA BLDG., SUITE 203
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City | BUTLER
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State | PA
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Zip | 16001-1956
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Country | US
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Telephone | 724-285-4153
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | DR. JOHN P KEELAN
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Credential | D.M.D.
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Telephone | 724-285-4153
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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 | DS026867L
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License Number State | PA
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