Provider Demographics
NPI:1376949578
Name:KEON, ALEC EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEC
Middle Name:EDWARD
Last Name:KEON
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 1:319 PITNEY PL
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6195
Mailing Address - Country:US
Mailing Address - Phone:508-237-6153
Mailing Address - Fax:
Practice Address - Street 1:319 PITNEY PL
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6195
Practice Address - Country:US
Practice Address - Phone:508-237-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-15
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02585500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist