Provider Demographics
NPI:1811089030
Name:KEAHEY, SHAWN (DDS)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:KEAHEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4146 CARMICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3634
Mailing Address - Country:US
Mailing Address - Phone:334-270-9924
Mailing Address - Fax:334-270-9904
Practice Address - Street 1:1608B GILMER AVENUE
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078
Practice Address - Country:US
Practice Address - Phone:334-283-8115
Practice Address - Fax:334-283-2610
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist