Provider Demographics
NPI:1467770537
Name:KEENER, JEREMY MARC (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MARC
Last Name:KEENER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PARADISE AVE
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-2700
Mailing Address - Country:US
Mailing Address - Phone:775-625-7763
Mailing Address - Fax:775-623-9256
Practice Address - Street 1:15 PARADISE AVE
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-2700
Practice Address - Country:US
Practice Address - Phone:775-625-7763
Practice Address - Fax:775-623-9256
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist