Provider Demographics
NPI:1962292649
Name:DYLAN J. KEENER, D.M.D., M.S., P.C.
Entity type:Organization
Organization Name:DYLAN J. KEENER, D.M.D., M.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KEENER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-507-2685
Mailing Address - Street 1:2639 HOLKHAM DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-9527
Mailing Address - Country:US
Mailing Address - Phone:717-507-2685
Mailing Address - Fax:
Practice Address - Street 1:240 HYDRAULIC RIDGE RD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8130
Practice Address - Country:US
Practice Address - Phone:434-973-6542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty