Provider Demographics
NPI:1962404301
Name:KEENAN, CHRISTOPHER TIMOTHY (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TIMOTHY
Last Name:KEENAN
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 1:810 RIVER RUSH DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7462
Mailing Address - Country:US
Mailing Address - Phone:770-826-7710
Mailing Address - Fax:706-857-7041
Practice Address - Street 1:64 STOCKADE RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-1900
Practice Address - Country:US
Practice Address - Phone:706-857-2323
Practice Address - Fax:706-857-7041
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0131521223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice