Provider Demographics
NPI:1073734372
Name:KEOWN, MARCY LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARCY
Middle Name:LYNN
Last Name:KEOWN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 S ALAFAYA TRL
Mailing Address - Street 2:SUITE 200
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:407-482-1408
Practice Address - Street 1:1549 S ALAFAYA TRL
Practice Address - Street 2:SUITE 200
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:407-482-1408
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN179211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001356800Medicaid