Provider Demographics
NPI:1740235621
Name:KEEFE, MARIAN KATHLEEEN (DMD)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:KATHLEEEN
Last Name:KEEFE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 OTTER POINT RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7947
Mailing Address - Country:US
Mailing Address - Phone:850-474-9633
Mailing Address - Fax:
Practice Address - Street 1:7220 PINE FOREST RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-3924
Practice Address - Country:US
Practice Address - Phone:850-944-0116
Practice Address - Fax:850-944-0188
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN92481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice