Provider Demographics
NPI:1407406879
Name:JED D. KEENER DDS LLC
Entity Type:Organization
Organization Name:JED D. KEENER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JED
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEENER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-548-4064
Mailing Address - Street 1:200 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2112
Mailing Address - Country:US
Mailing Address - Phone:541-548-4064
Mailing Address - Fax:541-923-2355
Practice Address - Street 1:200 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2112
Practice Address - Country:US
Practice Address - Phone:541-548-4064
Practice Address - Fax:541-923-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty