Organization
KEENAN R. DECKER D.M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEENAN R DECKER D.M.D. (DENTIST)
(479) 770-4333
Entity
Organization
Contact information
Practice address
1815 BILLIE ACRES PL, LOWELL, AR 72745-8641
(479) 770-4333
(479) 770-4334
Mailing address
PO BOX 1037, LOWELL, AR 72745-1037
(479) 770-4333
(479) 770-4334
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5S900
BLUE CROSS BLUE SHIELD
AR
Enumeration date
04/29/2008
Last updated
04/29/2008
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