Provider Demographics
NPI:1235513110
Name:CAVE, KEENAN (DMD)
Entity Type:Individual
Prefix:
First Name:KEENAN
Middle Name:
Last Name:CAVE
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 1:7441 HEATHROW WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-9503
Mailing Address - Country:US
Mailing Address - Phone:812-521-3158
Mailing Address - Fax:812-339-7383
Practice Address - Street 1:7441 HEATHROW WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-9503
Practice Address - Country:US
Practice Address - Phone:317-856-5544
Practice Address - Fax:317-856-9662
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012381A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist