Provider Demographics
NPI:1447476791
Name:RICHARD W. KEELING
Entity type:Organization
Organization Name:RICHARD W. KEELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILEY
Authorized Official - Last Name:KEELING
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-447-7313
Mailing Address - Street 1:4215 HILLVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-3817
Mailing Address - Country:US
Mailing Address - Phone:502-447-7313
Mailing Address - Fax:
Practice Address - Street 1:4215 HILLVIEW AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-3817
Practice Address - Country:US
Practice Address - Phone:502-447-7313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty