Provider Demographics
NPI:1730308073
Name:KEOUGH, LEE ANNE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:LEE ANNE
Middle Name:
Last Name:KEOUGH
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4471
Mailing Address - Country:US
Mailing Address - Phone:352-351-5588
Mailing Address - Fax:352-351-9207
Practice Address - Street 1:2701 SW 34TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4471
Practice Address - Country:US
Practice Address - Phone:352-351-5588
Practice Address - Fax:352-351-9207
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00134621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics