Provider Demographics
NPI:1326267675
Name:KEOUGH HUMBERSON, ALANA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALANA
Middle Name:M
Last Name:KEOUGH HUMBERSON
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 1:3379 OCEAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963
Mailing Address - Country:US
Mailing Address - Phone:772-234-3333
Mailing Address - Fax:772-234-1509
Practice Address - Street 1:3379 OCEAN DRIVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963
Practice Address - Country:US
Practice Address - Phone:772-234-3333
Practice Address - Fax:772-234-1509
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 167401223E0200X
FLDN-167401223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics