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General NPI Number Information
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NPI Number | 1043495229
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Entity Type | Individual
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Provider Name | JEFFREY THOMAS KEESLER DDS, MS, MS
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Gender | Male
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 1524 S COMMERCIAL ST
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City | NEENAH
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State | WI
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Zip | 54956-4802
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Country | US
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Telephone | 920-729-0889
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Fax |
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Provider Business Mailing Address
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Address Line | 1524 S COMMERCIAL ST
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City | NEENAH
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State | WI
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Zip | 54956-4802
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | WI 4027-015
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | WI 4027-015
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License Number State | WI
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