Provider Demographics
NPI:1164643607
Name:KEEFE, THERESA (DMD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:KEEFE
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 1:191 ALBANY TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019
Mailing Address - Country:US
Mailing Address - Phone:860-693-0887
Mailing Address - Fax:860-693-1079
Practice Address - Street 1:191 ALBANY TURNPIKE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019
Practice Address - Country:US
Practice Address - Phone:860-693-0887
Practice Address - Fax:860-693-1079
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8462122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice