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General NPI Number Information
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NPI Number | 1699158089
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Entity Type | Individual
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Provider Name | KELLIE O'KEEFE DMD
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Gender | Female
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 2940 STANLEY RD
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City | SAN ANTONIO
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State | TX
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Zip | 78234-2740
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Country | US
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Telephone | 210-466-5730
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 CONNELL RD
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-7664
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Country | US
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Telephone | 210-466-5730
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 11423
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 11423
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License Number State | CT
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