Individual
DR. KEITH A. BOENNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., LLC
Contact information
Practice address
1104 KENILWORTH DR, SUITE 104, TOWSON, MD 21204-2101
(410) 828-1717
(410) 821-0912
Mailing address
1104 KENILWORTH DR, SUITE 104, TOWSON, MD 21204-2101
(410) 828-1717
(410) 821-0912
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
8257
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26-2579369
FEDERAL TAX ID
MD
Enumeration date
02/22/2007
Last updated
07/01/2008
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