Provider Demographics
NPI:1073875498
Name:KEATING, KEVIN CASEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CASEY
Last Name:KEATING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 ROCKGLEN LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2167
Mailing Address - Country:US
Mailing Address - Phone:336-339-1966
Mailing Address - Fax:
Practice Address - Street 1:3500 GROVE AVE STE 104
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2220
Practice Address - Country:US
Practice Address - Phone:804-358-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014147091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice