Organization
GARY G. KEENER DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY G KEENER DDS, PA (OWNER)
(501) 835-4655
Entity
Organization
Contact information
Practice address
9509 HIGHWAY 107, SHERWOOD, AR 72120-2634
(501) 835-4655
(501) 835-4658
Mailing address
9509 HIGHWAY 107, SHERWOOD, AR 72120-2634
(501) 835-4655
(501) 835-4658
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4030062
BLUE CROSS BLUE SHIELD OF TENNESSEE
TN
01
—
58905
ARK BLUE CROSS BLUE SHIELD FEP
AR
01
—
824306
ARK BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/07/2008
Last updated
07/07/2008
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