Blake Clete Keen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

111167 Issued in CA

Practice address

9606 Base Line Rd
Rancho Cucamonga, CA 91701-5035

Phone

(909) 989-6661

Fax

(909) 989-6663

NPI assigned

Jan 15, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1033920400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9137",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917011137",
            "telephone_number": "909-989-6661",
            "fax_number": "909-989-6663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9606 BASE LINE RD",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917015035",
            "telephone_number": "909-989-6661",
            "fax_number": "909-989-6663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEEN",
        "first_name": "BLAKE",
        "middle_name": "CLETE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-15",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "111167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Traviana Kazee, ED.S
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• KCT Psychotherapy & Consulting
• Kelsie Keating, LCSW
• Kayla Keeling, RBT
• Rachel Joy Keener
• John Kelleher
• Demetri Rashad Kelley
• Afton Valley Kelly
• Ian Kelly

• General Practice Dentistry in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.