Provider Demographics
NPI:1659435170
Name:KEANE, MARTIN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:A
Last Name:KEANE
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 1:1 PLUMMERS CORNER
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588
Mailing Address - Country:US
Mailing Address - Phone:508-234-6634
Mailing Address - Fax:508-234-2552
Practice Address - Street 1:1 PLUMMERS CORNER
Practice Address - Street 2:SUITE 103
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588
Practice Address - Country:US
Practice Address - Phone:508-234-6634
Practice Address - Fax:508-234-2552
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA141021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice