Provider Demographics
NPI:1104302512
Name:KEENER, JED D (DDS)
Entity type:Individual
Prefix:DR
First Name:JED
Middle Name:D
Last Name:KEENER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2112
Mailing Address - Country:US
Mailing Address - Phone:541-548-4064
Mailing Address - Fax:541-923-2355
Practice Address - Street 1:200 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2112
Practice Address - Country:US
Practice Address - Phone:541-548-4064
Practice Address - Fax:541-923-2355
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD108571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice