Provider Demographics
NPI:1023027265
Name:KEIM,, DOUGLAS KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:KENNETH
Last Name:KEIM,
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 HAMLINE AVE N
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5009
Mailing Address - Country:US
Mailing Address - Phone:651-631-2944
Mailing Address - Fax:651-639-1439
Practice Address - Street 1:2233 HAMLINE AVE N
Practice Address - Street 2:SUITE 210
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5009
Practice Address - Country:US
Practice Address - Phone:651-631-2944
Practice Address - Fax:651-639-1439
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND72121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice