Provider Demographics
NPI:1437950169
Name:BORGELIN, KEILY LESLIE (DDS)
Entity type:Individual
Prefix:DR
First Name:KEILY
Middle Name:LESLIE
Last Name:BORGELIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8435 MARLO AVE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-0007
Mailing Address - Country:US
Mailing Address - Phone:561-410-4713
Mailing Address - Fax:
Practice Address - Street 1:9 TRI PARK WAY
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1661
Practice Address - Country:US
Practice Address - Phone:920-882-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI6001833-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program