Individual
KEITH J DOUBLEDAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6856 LEE RD., HARTFORD, WI 53027
(262) 673-7611
Mailing address
PO BOX 270197, HARTFORD, WI 53027-0197
(262) 673-7611
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2316
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33408700
—
WI
Enumeration date
10/27/2006
Last updated
07/09/2007
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