Provider Demographics
NPI:1558655597
Name:O'KEEFE, ANNA VIRGINIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:VIRGINIA
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:VIRGINIA
Other - Last Name:CZECHOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:93 MAIN ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6636
Mailing Address - Country:US
Mailing Address - Phone:207-872-8891
Mailing Address - Fax:207-872-0946
Practice Address - Street 1:93 MAIN ST
Practice Address - Street 2:SUITE 15
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6636
Practice Address - Country:US
Practice Address - Phone:207-872-8891
Practice Address - Fax:207-872-0946
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist