Keystone South Milwaukee LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

KEYSTONE SOUTH MILWAUKEE LLC

Practice address

1113 College Ave # B
South Milwaukee, WI 53172-1142

Phone

(414) 764-0212

NPI assigned

Mar 2, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Tammy Kevin

Title

Director of Operations

Phone

(262) 873-0510

Specialties & licenses 1

Addresses

Other names 1

• South Milwaukee Family Dental Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614643200000",
    "number": "1114512225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 180163",
            "city": "DELAFIELD",
            "state": "WI",
            "postal_code": "530180163",
            "telephone_number": "262-873-0510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 COLLEGE AVE # B",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531721142",
            "telephone_number": "414-764-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE SOUTH MILWAUKEE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-02",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A",
        "authorized_official_last_name": "KEVIN",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "262-873-0510",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Milwaukee Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Muhammad Kamil
• Mark Kaminski
• Deena Karnowski
• Carol Kaspar, PT
• Julie Keith
• Andrea Kijek
• King Home Assistance LLC
• Canon Klauer, HIS
• Taylor Klaver
• Ki Hyuk Ko, RPH

• Dental Clinic/Center in South Milwaukee, WI
• Providers in South Milwaukee, WI by specialty
• Dental Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.