Provider Demographics
NPI:1164525374
Name:DILLARD, KEITH ALAN (DMD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ALAN
Last Name:DILLARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9108 HELENA RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2739
Mailing Address - Country:US
Mailing Address - Phone:205-988-4530
Mailing Address - Fax:205-988-8140
Practice Address - Street 1:9108 HELENA RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-2739
Practice Address - Country:US
Practice Address - Phone:205-988-4530
Practice Address - Fax:205-988-8140
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL39311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice