Provider Demographics
NPI:1760353585
Name:MCKEOWN FAMILY DENTAL, PLLC
Entity type:Organization
Organization Name:MCKEOWN FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEOWN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:231-450-3466
Mailing Address - Street 1:224 S WEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1571
Mailing Address - Country:US
Mailing Address - Phone:231-450-3466
Mailing Address - Fax:
Practice Address - Street 1:224 S WEAVER AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1571
Practice Address - Country:US
Practice Address - Phone:231-450-3466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty