Provider Demographics
NPI:1487086583
Name:KEENER, DYLAN JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:JAMES
Last Name:KEENER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 HYDRAULIC RIDGE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8130
Mailing Address - Country:US
Mailing Address - Phone:434-973-6542
Mailing Address - Fax:434-973-6962
Practice Address - Street 1:240 HYDRAULIC RIDGE RD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8130
Practice Address - Country:US
Practice Address - Phone:434-973-6542
Practice Address - Fax:434-973-6962
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014192611223X0400X
PADS039683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No122300000XDental ProvidersDentist