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General NPI Number Information
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NPI Number | 1154473049
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Entity Type | Individual
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Provider Name | KEITH A STUMMER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3100 80TH ST
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City | KENOSHA
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State | WI
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Zip | 53142-4946
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Country | US
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Telephone | 262-694-2961
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Fax | 262-942-7340
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Provider Business Mailing Address
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Address Line | 4467 114TH ST
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-3860
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Country | US
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Telephone | 262-764-0368
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3556015
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License Number State | WI
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