Provider Demographics
NPI:1346628021
Name:KEWAYGESHIK, JANE MORGAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:MORGAN
Last Name:KEWAYGESHIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:MORGAN
Other - Last Name:KREUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:640 23RD ST S
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-1714
Mailing Address - Country:US
Mailing Address - Phone:715-498-9214
Mailing Address - Fax:
Practice Address - Street 1:640 23RD ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-1714
Practice Address - Country:US
Practice Address - Phone:715-498-9214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI1001088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program