Provider Demographics
NPI:1508072232
Name:TEMPLIN, KEITH (DDS)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:TEMPLIN
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:N97W14984 BURNING BUSH CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6628
Mailing Address - Country:US
Mailing Address - Phone:126-225-5713
Mailing Address - Fax:
Practice Address - Street 1:N112W16760 MEQUON RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-5814
Practice Address - Country:US
Practice Address - Phone:126-225-5782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice