Provider Demographics
NPI:1104843184
Name:KEATING, DANIEL J (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:KEATING
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 1:7213 KINGSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:SLATINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18080-2221
Mailing Address - Country:US
Mailing Address - Phone:610-462-7203
Mailing Address - Fax:
Practice Address - Street 1:3420 WALBERT AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-1700
Practice Address - Country:US
Practice Address - Phone:610-366-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist