Organization
JOHN T. KEAVENY, DDS
Active
Other names
Oral & Maxillofacial Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN TEUNIS KEAVENY DDS (OWNER)
(701) 225-5163
Entity
Organization
Contact information
Practice address
669 12TH ST W, DICKINSON, ND 58601-3554
(701) 225-5163
(701) 264-1032
Mailing address
669 12TH ST W, DICKINSON, ND 58601-3554
(701) 225-5163
(701) 264-1032
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1444
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26747
BCBS MEDICAL
ND
05
—
41384
—
ND
01
—
949318
DSC DENTAL
ND
Enumeration date
05/10/2007
Last updated
10/04/2007
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