Individual provider Active NPI

Theresa Keefe, D.M.D.

  • Dentist
  • Canton, CT
National Provider Identifier
1164643607
Registry record updated Oct 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8462 Issued in CT
Practice address
191 Albany Turnpike
Canton, CT 06019
Phone
(860) 693-0887
Fax
(860) 693-1079
NPI assigned
May 1, 2007
Last updated
Oct 31, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 8462 CT Primary
General Practice Dentistry 1223G0001X 8462 CT

Addresses

Primary practice location

191 Albany Turnpike
Canton, CT 06019

Mailing address

191 Albany Turnpike
Canton, CT 06019
Phone (860) 693-0887

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150717000052 CT Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 2365755584

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8462CTMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Canton Valley Dental LLC General Practice CurrentSince Feb 1, 2016 Accepting new patients

Locations

191 Albany Tpke
Canton, CT 06019
Phone (860) 693-0887

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383177600000",
    "number": "1164643607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 ALBANY TURNPIKE",
            "city": "CANTON",
            "state": "CT",
            "postal_code": "06019",
            "telephone_number": "860-693-0887",
            "fax_number": "860-693-1079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 ALBANY TURNPIKE",
            "city": "CANTON",
            "state": "CT",
            "postal_code": "06019",
            "telephone_number": "860-693-0887",
            "fax_number": "860-693-1079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEEFE",
        "first_name": "THERESA",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2013-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "8462",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "8462",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, CT

Sources for this page

Verify at the official NPI Registry.