Provider Demographics
NPI:1376947259
Name:KEITH A. MEHNER, D.D.S.,P.L.L.C
Entity Type:Organization
Organization Name:KEITH A. MEHNER, D.D.S.,P.L.L.C
Other - Org Name:MCLOUD FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-964-2500
Mailing Address - Street 1:403 W. BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851-8266
Mailing Address - Country:US
Mailing Address - Phone:405-964-2500
Mailing Address - Fax:405-964-2515
Practice Address - Street 1:403 W. BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851-8266
Practice Address - Country:US
Practice Address - Phone:405-964-2500
Practice Address - Fax:405-964-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty