Provider Demographics
NPI:1437403532
Name:KECK, MEGAN BARTLETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:BARTLETT
Last Name:KECK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:BARTLETT
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:151 EAST BOW STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:THORNTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46071
Mailing Address - Country:US
Mailing Address - Phone:765-436-2433
Mailing Address - Fax:765-436-2551
Practice Address - Street 1:151 EAST BOW STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:THORNTOWN
Practice Address - State:IN
Practice Address - Zip Code:46071
Practice Address - Country:US
Practice Address - Phone:765-436-2433
Practice Address - Fax:765-436-2551
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011840A122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12011840AOtherDENTAL LICENSE