Provider Demographics
NPI:1639170400
Name:KEENER, MARK STEVEN (DMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:KEENER
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 1:20900 YOUNG AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8461
Mailing Address - Country:US
Mailing Address - Phone:541-548-4064
Mailing Address - Fax:541-923-2355
Practice Address - Street 1:200 S. 7TH ST.
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756
Practice Address - Country:US
Practice Address - Phone:541-548-4064
Practice Address - Fax:541-923-2355
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD67191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice