Provider Demographics
NPI:1588678502
Name:KEENE, JOHN ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:KEENE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:393 FRANKLIN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1222
Mailing Address - Country:US
Mailing Address - Phone:516-437-9600
Mailing Address - Fax:516-437-9603
Practice Address - Street 1:959 BRUSH HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1778
Practice Address - Country:US
Practice Address - Phone:516-333-5900
Practice Address - Fax:516-333-5868
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0529781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery