Provider Demographics
NPI:1306009741
Name:GARY G. KEENER DDS, PA
Entity Type:Organization
Organization Name:GARY G. KEENER DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:KEENER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:501-835-4655
Mailing Address - Street 1:9509 HIGHWAY 107
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-2634
Mailing Address - Country:US
Mailing Address - Phone:501-835-4655
Mailing Address - Fax:501-835-4658
Practice Address - Street 1:9509 HIGHWAY 107
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-2634
Practice Address - Country:US
Practice Address - Phone:501-835-4655
Practice Address - Fax:501-835-4658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58905OtherARK BLUE CROSS BLUE SHIELD FEP
IL824306OtherARK BLUE CROSS BLUE SHIELD
TN4030062OtherBLUE CROSS BLUE SHIELD OF TENNESSEE