Provider Demographics
NPI:1447460076
Name:JOHN T. O'KEEFE, DDS, PLLC
Entity type:Organization
Organization Name:JOHN T. O'KEEFE, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:MARIAN
Authorized Official - Last Name:O'KEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:509-996-4133
Mailing Address - Street 1:PO BOX 1185
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:WA
Mailing Address - Zip Code:98862-1185
Mailing Address - Country:US
Mailing Address - Phone:509-996-4133
Mailing Address - Fax:509-996-4133
Practice Address - Street 1:115 SOUTH GLOVER
Practice Address - Street 2:
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856
Practice Address - Country:US
Practice Address - Phone:509-997-7533
Practice Address - Fax:509-997-7543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA54621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5001300Medicare ID - Type UnspecifiedGROUP NUMBER
WA5044748Medicare ID - Type UnspecifiedDENTIST PROVIDER NUMBER