Provider Demographics
NPI:1528280351
Name:FEDOSKY, KEANE E (DDS)
Entity type:Individual
Prefix:DR
First Name:KEANE
Middle Name:E
Last Name:FEDOSKY
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:P.O. BOX 1490
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-1490
Mailing Address - Country:US
Mailing Address - Phone:972-475-0301
Mailing Address - Fax:972-463-3849
Practice Address - Street 1:4518 ROWLETT RD
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-5081
Practice Address - Country:US
Practice Address - Phone:972-475-0301
Practice Address - Fax:972-463-3849
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice