=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790764595
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OKEEF & HINRICHS DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4102 ELECTRIC RD SW
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-772-9515
-----------------------------------------------------
Fax | 540-772-0716
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4102 ELECTRIC RD SW
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-772-9515
-----------------------------------------------------
Fax | 540-772-0716
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EDWARD MICHAEL OKEEFE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 540-772-9515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401004137
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 0401008987
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------