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Individual

C MARK KEEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
9606 BASELINE RD, ALTA LOMA, CA 91701
(909) 989-6661
(909) 989-6663
Mailing address
9606 BASELINE RD, ALTA LOMA, CA 91701
(909) 989-6661
(909) 989-6663

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
37845
CA

Other

Enumeration date
06/06/2007
Last updated
07/08/2007
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