Basic Information
Provider Information
NPI: 1609138569
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KEECH
FirstName: RICHARD
MiddleName: C
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7206 F ST
Address2:  
City: LITTLE ROCK
State: AR
PostalCode: 722052621
CountryCode: US
TelephoneNumber: 5019444617
FaxNumber:  
Practice Location
Address1: 3024 S UNIVERSITY AVE
Address2:  
City: LITTLE ROCK
State: AR
PostalCode: 722046008
CountryCode: US
TelephoneNumber: 5015650606
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/15/2012
LastUpdateDate: 04/22/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X3870ARY Dental ProvidersDentist 

No ID Information.


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