Provider Demographics
NPI:1154412336
Name:KEAN, RICHARD A (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:KEAN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 HALCYON SUMMIT DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7047
Mailing Address - Country:US
Mailing Address - Phone:334-277-3492
Mailing Address - Fax:334-277-9432
Practice Address - Street 1:7200 HALCYON SUMMIT DRIVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7047
Practice Address - Country:US
Practice Address - Phone:334-277-3492
Practice Address - Fax:334-277-9432
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51591092OtherBCBS OF ALABAMA
AL009983340Medicaid
AL51005744OtherBCBS ALABAMA
AL51092494OtherBCBS OF ALABAMA
AL000092494Medicaid
AL009910631Medicaid
AL009983330Medicaid
AL852063OtherUNITED CONCORDIA
AL51517275OtherBCBS OF ALABAMA
AL51005744OtherBCBS ALABAMA
AL51591092OtherBCBS OF ALABAMA