Provider Demographics
NPI:1821657347
Name:KEESLER, COLEMAN PATRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLEMAN
Middle Name:PATRICK
Last Name:KEESLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 E CALUMET ST STE 600
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-4163
Mailing Address - Country:US
Mailing Address - Phone:920-968-5000
Mailing Address - Fax:
Practice Address - Street 1:6855 S 27TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8045
Practice Address - Country:US
Practice Address - Phone:414-435-0787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-08
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10020691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice