Provider Demographics
NPI:1740654011
Name:KEENE, DDS AND WALTERS, DMD, PLLC
Entity type:Organization
Organization Name:KEENE, DDS AND WALTERS, DMD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-362-7878
Mailing Address - Street 1:1001 W WILLIAMS ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3978
Mailing Address - Country:US
Mailing Address - Phone:919-362-7878
Mailing Address - Fax:919-362-6214
Practice Address - Street 1:1001 W WILLIAMS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3978
Practice Address - Country:US
Practice Address - Phone:919-362-7878
Practice Address - Fax:919-362-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9143122300000X
NC8649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty