Provider Demographics
NPI:1144300518
Name:KEMPKEN, BRUCE M (DDS)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:M
Last Name:KEMPKEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:53181-1005
Mailing Address - Country:US
Mailing Address - Phone:262-877-3353
Mailing Address - Fax:262-877-3353
Practice Address - Street 1:348 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:TWIN LAKES
Practice Address - State:WI
Practice Address - Zip Code:53181
Practice Address - Country:US
Practice Address - Phone:262-877-3353
Practice Address - Fax:262-877-3353
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice