Provider Demographics
NPI:1205625183
Name:MANESH, KEON B (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KEON
Middle Name:B
Last Name:MANESH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6831 WISCONSIN AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6122
Mailing Address - Country:US
Mailing Address - Phone:301-986-8777
Mailing Address - Fax:
Practice Address - Street 1:6831 WISCONSIN AVE STE 302
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6122
Practice Address - Country:US
Practice Address - Phone:301-986-8777
Practice Address - Fax:301-986-8873
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18655122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty