Organization
KEITH W JAESCHKE DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH W JAESCHKE DDS (OWNER)
(815) 942-0182
Entity
Organization
Contact information
Practice address
1545 CREEK DR, MORRIS, IL 60450-3004
(815) 942-0182
(815) 942-0966
Mailing address
1545 CREEK DR, MORRIS, IL 60450-3004
(815) 942-0182
(815) 942-0966
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.016384
IL
122300000X
Dentist
019.016659
IL
122300000X
Dentist
019.020128
IL
Other
Enumeration date
08/03/2010
Last updated
08/03/2010
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