Provider Demographics
NPI:1205219839
Name:KEEN, CARY ALEXANDER
Entity type:Individual
Prefix:
First Name:CARY
Middle Name:ALEXANDER
Last Name:KEEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 ARBOR TRL
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-7170
Mailing Address - Country:US
Mailing Address - Phone:336-707-7456
Mailing Address - Fax:
Practice Address - Street 1:210 ARTHUR DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-6275
Practice Address - Country:US
Practice Address - Phone:336-476-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10122122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist