Provider Demographics
NPI:1770876633
Name:KEIPPEL, JEFFERY WYATT (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:WYATT
Last Name:KEIPPEL
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 1:5401 LA SALLE ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1339
Mailing Address - Country:US
Mailing Address - Phone:402-486-3945
Mailing Address - Fax:
Practice Address - Street 1:40TH & HOLDREGE ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503
Practice Address - Country:US
Practice Address - Phone:402-472-3249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0080241223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics