Provider Demographics
NPI:1932246592
Name:TERRANCE J. O'KEEFE DDS LLC
Entity type:Organization
Organization Name:TERRANCE J. O'KEEFE DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'KEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-377-1670
Mailing Address - Street 1:21 WILLOW POND WAY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2687
Mailing Address - Country:US
Mailing Address - Phone:585-377-1670
Mailing Address - Fax:585-377-1724
Practice Address - Street 1:21 WILLOW POND WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2687
Practice Address - Country:US
Practice Address - Phone:585-377-1670
Practice Address - Fax:585-377-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053057-11223G0001X
NY0406911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70656MAOtherEXCELLUS BLUE CROSS BLUE
NY70657TOOtherEXCELLUS BLUE CROSS BLUE