Provider Demographics
NPI:1720302540
Name:KEAN DENTAL INC
Entity Type:Organization
Organization Name:KEAN DENTAL INC
Other - Org Name:ORANGE COUNTY DENTAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:KEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-789-8989
Mailing Address - Street 1:15825 LAGUNA CANYON RD STE 206
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2127
Mailing Address - Country:US
Mailing Address - Phone:949-789-8989
Mailing Address - Fax:949-453-0970
Practice Address - Street 1:15825 LAGUNA CANYON RD STE 206
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2127
Practice Address - Country:US
Practice Address - Phone:949-789-8989
Practice Address - Fax:949-453-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA580391223E0200X
CA510851223E0200X
CA577391223G0001X
CA499341223P0221X
CA245731223P0300X
CA323081223P0300X
CA571951223P0700X
CA303991223P0700X
CA531631223S0112X
CA563281223S0112X
CA532461223X0400X
CA306931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609944867OtherSTEVE MIAO
CA1801003637OtherBRIAN THAI
CA1124034129OtherWILLIAM MIHRAM
CA1225118417OtherSAM GILANI
CA1598916058OtherKEVIN KEAN
CA1164698379OtherFADI KATTAR
CA1184678930OtherCHRISTOPHER PACE
CA1912114059OtherALI MANOUCHEHRI
CA1598916058OtherALAN SHELHAMER
CA1245459379OtherMASSOUD KASHANCHI
CA1720117534OtherHAMILTON LE