Provider Demographics
NPI:1457688004
Name:KEANE-DAWES, RONIQUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONIQUE
Middle Name:
Last Name:KEANE-DAWES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1386 GRAY HWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1952
Mailing Address - Country:US
Mailing Address - Phone:478-745-5239
Mailing Address - Fax:478-745-5248
Practice Address - Street 1:400 GALLERIA PKWY SE
Practice Address - Street 2:SUITE 800
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5980
Practice Address - Country:US
Practice Address - Phone:678-904-5665
Practice Address - Fax:678-904-5666
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0140071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice