Provider Demographics
NPI:1245760255
Name:KEPLER, CHELSEA A (DDS)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:A
Last Name:KEPLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:TEMPLETON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1500 E. MEDICAL CENTER DRIVE
Mailing Address - Street 2:MEDINN CLINIC, C213, SPC 5831
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR SPC 5831
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5000
Practice Address - Country:US
Practice Address - Phone:734-936-5950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010223041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN54670913OtherDENTPIN
IN300019447Medicaid