1740654011 NPI number — KEENE, DDS AND WALTERS, DMD, PLLC

Table of content: (NPI 1740654011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740654011 NPI number — KEENE, DDS AND WALTERS, DMD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEENE, DDS AND WALTERS, DMD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740654011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 W WILLIAMS ST
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
APEX
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27502-3978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-362-7878
Provider Business Mailing Address Fax Number:
919-362-6214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 W WILLIAMS ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
APEX
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27502-3978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-362-7878
Provider Business Practice Location Address Fax Number:
919-362-6214
Provider Enumeration Date:
11/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KEENE
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
919-362-7878

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  8649 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 9143 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com