Provider Demographics
NPI:1508013491
Name:KATHLEEN KEATING DDS, PC
Entity Type:Organization
Organization Name:KATHLEEN KEATING DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:JEANNETTE
Authorized Official - Last Name:KEATING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-834-7555
Mailing Address - Street 1:57 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2818
Mailing Address - Country:US
Mailing Address - Phone:781-834-7555
Mailing Address - Fax:
Practice Address - Street 1:57 FOREST ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2818
Practice Address - Country:US
Practice Address - Phone:781-834-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty