Provider Demographics
NPI:1174664403
Name:MCKEON, THOMAS C (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:MCKEON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 TORRINGTON OFFICE PLZ
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3854
Mailing Address - Country:US
Mailing Address - Phone:860-482-5779
Mailing Address - Fax:860-496-2345
Practice Address - Street 1:1 TORRINGTON OFFICE PLZ
Practice Address - Street 2:SUITE 103
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3854
Practice Address - Country:US
Practice Address - Phone:860-482-5779
Practice Address - Fax:860-496-2345
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT67741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT22101Medicare UPIN