Keenan R. Decker D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KEENAN R. DECKER D.M.D.

Practice address

1815 Billie Acres PL
Lowell, AR 72745-8641

Phone

(479) 770-4333

Fax

(479) 770-4334

NPI assigned

Apr 29, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Keenan R Decker, D.M.D.

Title

Dentist

Phone

(479) 770-4333

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1497920573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1037",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727451037",
            "telephone_number": "479-770-4333",
            "fax_number": "479-770-4334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 BILLIE ACRES PL",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727458641",
            "telephone_number": "479-770-4333",
            "fax_number": "479-770-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEENAN R. DECKER D.M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "DECKER",
        "authorized_official_first_name": "KEENAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "479-770-4333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5S900",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Lowell, AR
• Providers in Lowell, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; 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.