Provider Demographics
NPI:1720363716
Name:LINDBLAD, KEANE RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEANE
Middle Name:RYAN
Last Name:LINDBLAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BILLY JOHNSON DENTAL CLINIC
Mailing Address - Street 2:BLDG 36014 WRATTEN DR
Mailing Address - City:FT. CAVAZOS
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BILLY JOHNSON DENTAL CLINIC
Practice Address - Street 2:BLDG 36014 WRATTEN DR
Practice Address - City:FT. CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-444-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10380650-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice