Provider Demographics
NPI:1861584781
Name:KEENER, GARY G (DDS, PA)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:G
Last Name:KEENER
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9509 HIGHWAY 107
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-2634
Mailing Address - Country:US
Mailing Address - Phone:501-835-4655
Mailing Address - Fax:501-835-4658
Practice Address - Street 1:9509 HIGHWAY 107
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-2634
Practice Address - Country:US
Practice Address - Phone:501-835-4655
Practice Address - Fax:501-835-4658
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR824306OtherBLUE CROSS BLUE SHIELD
AR58905OtherFEDERAL BLUE CROSS