Kevin Keith Keen, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

1223S0112X Issued in MS

Practice address

1205 Mission Park Dr
Vicksburg, MS 39180-3747

Phone

(601) 661-0034

Fax

(601) 661-0367

NPI assigned

Jan 16, 2007

Last updated

Feb 26, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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)

Enrolled

State licenses

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.

• Southern Oral and Maxillofacial Surgery Center, Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Vicksburg, MS
  • NPI 1073784880
  Authorized official Same address or phone

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203984000000",
    "number": "1578614640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 MISSION PARK DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803747",
            "telephone_number": "601-661-0034",
            "fax_number": "601-661-0367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 MISSION PARK DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803747",
            "telephone_number": "601-661-0034",
            "fax_number": "601-661-0367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEEN",
        "first_name": "KEVIN",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2008-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MS",
            "license": "1223S0112X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• K McDaniel Inc
• Izzeddin Kamelmaz, MD
• Ashley L Karel, PMHNP-BC
• Simarjit Kaur, PA
• KCC Infusion, LLC (Vicksburg Infusion Center)
• Keeping Focus LLC.
• Logan Kelley, PHARM. D
• Madelyn Grace Kelly
• Rhonda Kemp, FNP
• Timothy P Kerut, MD

• Oral and Maxillofacial Surgery (Dentist) in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Oral and Maxillofacial Surgery (Dentist) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 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.