Provider Demographics
NPI:1215294848
Name:KEEN, ROBERT RICHARD (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:RICHARD
Last Name:KEEN
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 1:1915 WEST PARK DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3777
Mailing Address - Country:US
Mailing Address - Phone:336-667-5170
Mailing Address - Fax:336-903-7313
Practice Address - Street 1:1915 WEST PARK DRIVE
Practice Address - Street 2:SUITE #104
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3777
Practice Address - Country:US
Practice Address - Phone:336-667-5170
Practice Address - Fax:336-903-7313
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC#1508701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FK3001675OtherBNDD