Provider Demographics
NPI:1508951468
Name:KEENE, ANDREW F (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:F
Last Name:KEENE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 W MAIN ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3104
Mailing Address - Country:US
Mailing Address - Phone:203-573-1427
Mailing Address - Fax:203-574-2460
Practice Address - Street 1:1389 W MAIN ST
Practice Address - Street 2:SUITE 320
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3104
Practice Address - Country:US
Practice Address - Phone:203-573-1427
Practice Address - Fax:203-574-2460
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT42221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT190000385Medicare ID - Type UnspecifiedPROVIDER NUMBER
CT850000017Medicare PIN