Bryce Mark Keen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

105639 Issued in CA

Practice address

9606 Baseline Rd
Alta Loma, CA 91701-5035

Phone

(909) 989-6661

Fax

(909) 989-6663

NPI assigned

Oct 2, 2020

Last updated

Oct 2, 2020By the provider in NPPES

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": "1601596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1619574688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5029 LOMAS CT",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917371542",
            "telephone_number": "909-714-7105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9606 BASELINE RD",
            "city": "ALTA LOMA",
            "state": "CA",
            "postal_code": "917015035",
            "telephone_number": "909-989-6661",
            "fax_number": "909-989-6663"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16922 Main St Ste F",
            "address_purpose": "LOCATION",
            "city": "Hesperia",
            "state": "CA",
            "postal_code": "923456011",
            "country_code": "US",
            "telephone_number": "760-244-4844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEEN",
        "first_name": "BRYCE",
        "middle_name": "MARK",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-02",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "105639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley M Jimenez
• Jessica Elizabeth Johnson, FDN-P
• Tamara Lee Johnstone, LMFT
• Sara Jurado, MS
• Bryan Katz
• C Mark Keen, DDS
• Diana Patricia Ketterman, PH.D.
• Rene Key
• Michael Kim, D.D.S.
• Amany Mofied Kirollos

• General Practice Dentistry in Alta Loma, CA
• Providers in Alta Loma, 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 Oct 2, 2020; 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.