Adam Keenan

Individual provider Active NPI General Practice Dentistry · Prairie Du Chien, WI

NPI 1669118907 · NPPES record last updated May 10, 2022

Key facts

NPI
1669118907
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
NA (WI)
Practice address
110 S Ohio St
Prairie Du Chien, WI 53821-1642
Phone
(608) 326-8458
NPI assigned
May 10, 2022
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NA WI Yes

Addresses

Primary practice location

110 S Ohio St
Prairie Du Chien, WI 53821-1642

Mailing address

1414 E Parrish St
Prairie Du Chien, WI 53821-2917

Other providers in Prairie Du Chien, WI

All providers in Prairie Du Chien, WI · General Practice Dentistry in Wisconsin

Sources for this page

Verify at the official NPI Registry.