Provider Demographics
NPI:1669269460
Name:MCKEOWN, NATHAN (DMD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:MCKEOWN
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3284 N GREEN AVE
Mailing Address - Street 2:PO BOX 542
Mailing Address - City:HESPERIA
Mailing Address - State:MI
Mailing Address - Zip Code:49421
Mailing Address - Country:US
Mailing Address - Phone:231-450-3466
Mailing Address - Fax:
Practice Address - Street 1:3988 N OCEANA DR
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420
Practice Address - Country:US
Practice Address - Phone:231-450-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program