Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 03876 | NH |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 22DI01811500 | NJ |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 60194 | CA |
NPI | 1083685374 |
---|---|
Provider Name | Dr. Keith Christopher Kealey |
First Address | West Lebanon, NH 03784-1681 |
Second Address | West Lebanon, NH 03784-1681 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 09/11/2011 |