Provider Demographics
NPI:1194934919
Name:KEATING, JEFFREY M (DMD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:KEATING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 PINE GLEN RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2345
Mailing Address - Country:US
Mailing Address - Phone:215-860-2221
Mailing Address - Fax:215-702-1380
Practice Address - Street 1:214 PINE GLENN ROAD
Practice Address - Street 2:
Practice Address - City:LANGHONRE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-860-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026846L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice