Provider Demographics
NPI:1851534622
Name:THOMAS J. KEOHANE DDS PC
Entity Type:Organization
Organization Name:THOMAS J. KEOHANE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEOHANE
Authorized Official - Suffix:
Authorized Official - Credentials:D,DS
Authorized Official - Phone:716-853-6601
Mailing Address - Street 1:487 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1740
Mailing Address - Country:US
Mailing Address - Phone:716-853-6601
Mailing Address - Fax:716-853-6601
Practice Address - Street 1:487 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1740
Practice Address - Country:US
Practice Address - Phone:716-853-6601
Practice Address - Fax:716-853-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty