Provider Demographics
NPI:1306857578
Name:KEATON, MELISSA JANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JANE
Last Name:KEATON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:KEATON
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1703 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25320-9717
Mailing Address - Country:US
Mailing Address - Phone:304-984-1840
Mailing Address - Fax:
Practice Address - Street 1:200 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6444
Practice Address - Country:US
Practice Address - Phone:304-255-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV35531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice