Provider Demographics
NPI:1588783252
Name:KEOHAN, JOHN F (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:KEOHAN
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 1:310 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1203
Mailing Address - Country:US
Mailing Address - Phone:617-876-7238
Mailing Address - Fax:617-868-8650
Practice Address - Street 1:310 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1203
Practice Address - Country:US
Practice Address - Phone:617-876-7238
Practice Address - Fax:617-868-8650
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist