NPIMap

Organization Active NPI

Keith D. Clemence, DDS

  • General Practice Dentistry
  • Hales Corners, WI
National Provider Identifier
1710105630
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5001558 Issued in WI
Legal business name
KEITH D. CLEMENCE, DDS
Practice address
5751 S 108TH St
Hales Corners, WI 53130-1940
Phone
(414) 425-0120
Fax
(414) 425-0978
NPI assigned
Apr 23, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Keith D Clemence, DDSNPI 1811937808
Title
Owner
Phone
(414) 425-0120

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5001459 WI
General Practice Dentistry 1223G0001X 5001558 WI Primary

Addresses

Primary practice location

5751 S 108TH St
Hales Corners, WI 53130-1940

Mailing address

5751 S 108TH St
Hales Corners, WI 53130-1940
Phone (414) 425-0120

Other names 1

  • Clemence Dental Group Other name

National Provider Directory

National Provider Directory

Locations

5751 S 108th St
Hales Corners, WI 53130
Phone (414) 425-0120

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710105630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5751 S 108TH ST",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531301940",
            "telephone_number": "414-425-0120",
            "fax_number": "414-425-0978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5751 S 108TH ST",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531301940",
            "telephone_number": "414-425-0120",
            "fax_number": "414-425-0978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH D. CLEMENCE, DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLEMENCE",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-425-0120",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5001459",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5001558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clemence Dental Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hales Corners, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.