MEDICARE: DAVID KEENS-DOUGLAS

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	122300000X	Dentist	12013695A	IN

General Provider Information

NPI Number	:	1225703309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID KEENS-DOUGLAS

Provider Business Mailing Address
First Line	:	6820 PARK PL
Second Line	:	SUITE 117
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254
Country	:	US
Telephone Number	:	317-329-7373
Fax Number	:

Provider Business Practice Location Address
First Line	:	6820 PARK PL
Second Line	:	SUITE 117
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254
Country	:	US
Telephone Number	:	317-329-7373
Fax Number	:

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

Provider Enumeration Date	:	08/11/2021
Last Update Date	:	12/10/2025

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Directions to “ DAVID KEENS-DOUGLAS ” Practice Location

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