Provider Demographics
NPI:1760722904
Name:KEENE, CAMILLE REYNOLDS (RDHAP)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:REYNOLDS
Last Name:KEENE
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-0134
Mailing Address - Country:US
Mailing Address - Phone:707-246-9736
Mailing Address - Fax:
Practice Address - Street 1:168 E H ST
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3231
Practice Address - Country:US
Practice Address - Phone:707-246-9736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist