Provider Demographics
NPI:1801062237
Name:STEPHEN G. MCKEEVER, DDS, INC.
Entity type:Organization
Organization Name:STEPHEN G. MCKEEVER, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCKEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-233-1420
Mailing Address - Street 1:PO BOX 10099
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73706-0099
Mailing Address - Country:US
Mailing Address - Phone:580-233-1420
Mailing Address - Fax:580-233-2908
Practice Address - Street 1:1420 W OWEN K GARRIOTT RD
Practice Address - Street 2:BUILDING 3
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5751
Practice Address - Country:US
Practice Address - Phone:580-233-1420
Practice Address - Fax:580-233-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3026302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100087470AMedicaid