Provider Demographics
NPI:1750460242
Name:KEELEY, PATRICK MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:KEELEY
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 1:877 PACIFIC ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4459
Mailing Address - Country:US
Mailing Address - Phone:831-373-2141
Mailing Address - Fax:831-373-0824
Practice Address - Street 1:877 PACIFIC ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4459
Practice Address - Country:US
Practice Address - Phone:831-373-2141
Practice Address - Fax:831-373-0824
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA241271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT08563Medicare UPIN