Individual
RAEVEN B KEENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
80 PHOENIX AVE, WATERBURY, CT 06702-1418
(203) 756-8021
Mailing address
80 PHOENIX AVE, WATERBURY, CT 06702-1418
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
008937
CT
Other
Enumeration date
08/09/2019
Last updated
08/09/2019
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