Provider Demographics
NPI:1760691232
Name:KALMANEK, KEITH JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JOHN
Last Name:KALMANEK
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 1:913 LILY CACHE LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3131
Mailing Address - Country:US
Mailing Address - Phone:630-226-1000
Mailing Address - Fax:708-301-4236
Practice Address - Street 1:913 LILY CACHE LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3131
Practice Address - Country:US
Practice Address - Phone:630-226-1000
Practice Address - Fax:708-301-4236
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice