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General NPI Number Information
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NPI Number | 1720302540
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Entity Type | Organization
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Legal Business Name | KEAN DENTAL INC
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 15825 LAGUNA CANYON RD STE 206
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City | IRVINE
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State | CA
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Zip | 92618-2127
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Country | US
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Telephone | 949-789-8989
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Fax | 949-453-0970
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Provider Business Mailing Address
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Address Line | 15825 LAGUNA CANYON RD STE 206
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City | IRVINE
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State | CA
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Zip | 92618-2127
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Country | US
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Telephone | 949-789-8989
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Fax | 949-453-0970
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN CHRISTOPHER KEAN
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Credential | DDS
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Telephone | 949-789-8989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 58039
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 51085
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 57739
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 49934
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 24573
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 32308
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 30399
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License Number State | CA
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Taxonomy #8
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 53163
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License Number State | CA
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Taxonomy #9
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 56328
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License Number State | CA
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Taxonomy #10
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 53246
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License Number State | CA
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Taxonomy #11
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30693
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License Number State | CA
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Taxonomy #12
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 57195
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License Number State | CA
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