Provider Demographics
NPI:1588722953
Name:KEANE, BRIAN J (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:KEANE
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 1:334 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5258
Mailing Address - Country:US
Mailing Address - Phone:717-691-1615
Mailing Address - Fax:
Practice Address - Street 1:500 GETTYSBURG PIKE
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5155
Practice Address - Country:US
Practice Address - Phone:717-697-4609
Practice Address - Fax:717-691-5959
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN026063A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA143412OtherUNITED CONCORDIA