Provider Demographics
NPI:1750446910
Name:JAMESON, KEITH A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:JAMESON
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 1:1426 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-8314
Mailing Address - Country:US
Mailing Address - Phone:517-437-7339
Mailing Address - Fax:517-437-8982
Practice Address - Street 1:1426 HUDSON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-8314
Practice Address - Country:US
Practice Address - Phone:517-437-7339
Practice Address - Fax:517-437-8982
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI147201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice