Provider Demographics
NPI:1083785752
Name:KEIM, DAVID C (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
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 1:795 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3699
Mailing Address - Country:US
Mailing Address - Phone:406-752-8081
Mailing Address - Fax:406-752-8083
Practice Address - Street 1:795 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3699
Practice Address - Country:US
Practice Address - Phone:406-752-8081
Practice Address - Fax:406-752-8083
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011-3696Medicaid
MT55-12964Medicaid