Provider Demographics
NPI:1861571556
Name:KEO, DUONGVANNAK J (DMD)
Entity type:Individual
Prefix:DR
First Name:DUONGVANNAK
Middle Name:J
Last Name:KEO
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 1:295 S PLUMOSA ST
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3525
Mailing Address - Country:US
Mailing Address - Phone:321-452-6000
Mailing Address - Fax:321-453-8823
Practice Address - Street 1:295 S PLUMOSA
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4886
Practice Address - Country:US
Practice Address - Phone:321-452-6000
Practice Address - Fax:321-453-8823
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL139551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice