Provider Demographics
NPI:1649300237
Name:KEENE, GREGORY D (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
Last Name:KEENE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W SOUTH BOULDER RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8827
Mailing Address - Country:US
Mailing Address - Phone:303-665-5586
Mailing Address - Fax:303-736-2918
Practice Address - Street 1:255 W SOUTH BOULDER RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8827
Practice Address - Country:US
Practice Address - Phone:303-665-5586
Practice Address - Fax:303-736-2918
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7851122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist