Active NPI
Thomas Maurice Keane Jr., D.D.S.
- Oral and Maxillofacial Pathology Dentistry
- Bloomington, MN
National Provider Identifier
1891786224
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Pathology Dentistry
- License
- 9671
- Practice address
- 8900 Penn Ave So.
Suite 211
Bloomington, MN 55431 - Phone
- (952) 920-3844
- Fax
- (952) 920-3008
- NPI assigned
- Nov 3, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Pathology Dentistry | 1223P0106X | 9671 | MN | Primary |
Addresses
Primary practice location
8900 Penn Ave So.
Suite 211
Bloomington, MN 55431
Mailing address
8900 Penn Ave So.
Suite 211
Bloomington, MN 55431
Phone (952) 920-3844
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 776322100 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9671 | MN | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435104000000",
"number": "1891786224",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8900 PENN AVE SO.",
"address_2": "SUITE 211",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "55431",
"telephone_number": "952-920-3844",
"fax_number": "952-920-3008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8900 PENN AVE SO.",
"address_2": "SUITE 211",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "55431",
"telephone_number": "952-920-3844",
"fax_number": "952-920-3008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEANE",
"first_name": "THOMAS",
"middle_name": "MAURICE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-03",
"last_updated": "2015-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0106X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Pathology",
"state": "MN",
"license": "9671",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "776322100",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.