Provider Demographics
NPI:1043343999
Name:KEUL, WILLIAM J (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:KEUL
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 1:820 W SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:IA
Mailing Address - Zip Code:50273-2206
Mailing Address - Country:US
Mailing Address - Phone:515-462-4474
Mailing Address - Fax:515-462-2858
Practice Address - Street 1:820 W SUMMIT ST
Practice Address - Street 2:
Practice Address - City:WINTERSET
Practice Address - State:IA
Practice Address - Zip Code:50273-2206
Practice Address - Country:US
Practice Address - Phone:515-462-4474
Practice Address - Fax:515-462-2858
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA62181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1138529Medicaid