Provider Demographics
NPI:1710006945
Name:KEIM, MICHAEL L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:KEIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:2585 23RD AVE S
Mailing Address - Street 2:SUITE B
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6172
Mailing Address - Country:US
Mailing Address - Phone:701-293-0006
Mailing Address - Fax:701-293-7724
Practice Address - Street 1:2585 23RD AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6172
Practice Address - Country:US
Practice Address - Phone:701-293-0006
Practice Address - Fax:701-293-7724
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND17841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics