Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN17921 | FL |
NPI | 1073734372 |
---|---|
Provider Name | Dr. Marcy Lynn Keown |
First Address | Orlando, FL 32828-8962 |
Second Address | Orlando, FL 32828-8962 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 21/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001356800 | (05) | FL |