Provider Demographics
NPI:1922595834
Name:FINK, KEANE (DDS)
Entity Type:Individual
Prefix:
First Name:KEANE
Middle Name:
Last Name:FINK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36TH MEDICAL GROUP UNIT 14010 (AAFB GUAM)
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96542-4010
Mailing Address - Country:US
Mailing Address - Phone:671-366-6750
Mailing Address - Fax:
Practice Address - Street 1:52 MDGUNIT 3690
Practice Address - Street 2:
Practice Address - City:APO SPANGDAHLEM AB
Practice Address - State:APO SPANGDAHLEM AB
Practice Address - Zip Code:09126
Practice Address - Country:DE
Practice Address - Phone:314-452-8231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-154571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty