MEDICARE: DON R. KEEHN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30-01-4302	OH

General Provider Information

NPI Number	:	1073517348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DON R. KEEHN DDS

Provider Business Mailing Address
First Line	:	8191 BROADVIEW RD
Second Line	:	STE 102
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147-1661
Country	:	US
Telephone Number	:	440-526-7369
Fax Number	:	440-526-7369

Provider Business Practice Location Address
First Line	:	8191 BROADVIEW RD
Second Line	:	STE 102
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147-1661
Country	:	US
Telephone Number	:	440-526-7369
Fax Number	:	440-526-7369

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/08/2007

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