Provider Demographics
NPI:1578801072
Name:DR. PATRICK L. KEESEE
Entity Type:Organization
Organization Name:DR. PATRICK L. KEESEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEESEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-348-5800
Mailing Address - Street 1:120 W STEPHEN FOSTER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1465
Mailing Address - Country:US
Mailing Address - Phone:502-348-5800
Mailing Address - Fax:502-348-9990
Practice Address - Street 1:120 W STEPHEN FOSTER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1465
Practice Address - Country:US
Practice Address - Phone:502-348-5800
Practice Address - Fax:502-348-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7470122300000X
KY7247122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty