Provider Demographics
NPI:1013553635
Name:MARCY L. KEOWN, DMD, PA
Entity Type:Organization
Organization Name:MARCY L. KEOWN, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEOWN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-281-9101
Mailing Address - Street 1:1549 S ALAFAYA TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8962
Mailing Address - Country:US
Mailing Address - Phone:407-482-1405
Mailing Address - Fax:
Practice Address - Street 1:1549 S ALAFAYA TRL STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8962
Practice Address - Country:US
Practice Address - Phone:407-482-1405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty