Provider Demographics
NPI:1083685374
Name:KEALEY, KEITH CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:CHRISTOPHER
Last Name:KEALEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 AIRPORT RD
Mailing Address - Street 2:ATTN: KARLEEN MCKENNEY
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784-1681
Mailing Address - Country:US
Mailing Address - Phone:603-298-7557
Mailing Address - Fax:
Practice Address - Street 1:16 AIRPORT RD
Practice Address - Street 2:ATTN: KARLEEN MCKENNEY
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03784-1681
Practice Address - Country:US
Practice Address - Phone:603-298-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018115001223S0112X
NH038761223S0112X
CA601941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery