Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 0401006889 | VA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 0438000164 | VA |
NPI | 1043271935 |
---|---|
Provider Name | Dr. Kanyon R. Keeney |
First Address | Glen Allen, VA 23059 |
Second Address | Henrico, VA 23233-2323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 01/09/2021 |