Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | WI 4027-015 | WI |
Y | 1223X0400X | Orthodontists | WI 4027-015 | WI |
NPI | 1043495229 |
---|---|
Provider Name | Dr. Jeffrey Thomas Keesler |
First Address | Neenah, WI 54956-4802 |
Second Address | Neenah, WI 54956-4802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2008 |
Last Update Date | 07/01/2008 |