Provider Demographics
NPI:1528001666
Name:MELAAS, KEITH ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALAN
Last Name:MELAAS
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 1:3335 KNIARD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48370-3027
Mailing Address - Country:US
Mailing Address - Phone:248-693-4399
Mailing Address - Fax:248-814-7045
Practice Address - Street 1:25900 DEQUINDRE
Practice Address - Street 2:SUITE C
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-6107
Practice Address - Country:US
Practice Address - Phone:586-756-7900
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0129291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice