Provider Demographics
NPI:1932245925
Name:KEEFE, MARYELLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARYELLEN
Middle Name:
Last Name:KEEFE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 BROWN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-3606
Mailing Address - Country:US
Mailing Address - Phone:914-737-1444
Mailing Address - Fax:914-788-1370
Practice Address - Street 1:1016 BROWN ST STE 203
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-3606
Practice Address - Country:US
Practice Address - Phone:914-737-1444
Practice Address - Fax:914-788-1370
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0424131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice