Provider Demographics
NPI:1801925656
Name:MICHAEL A. KELLER DDS, PC
Entity type:Organization
Organization Name:MICHAEL A. KELLER DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:AAON
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:205-870-7110
Mailing Address - Street 1:2045 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:SUITE 5-7
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6874
Mailing Address - Country:US
Mailing Address - Phone:205-870-7110
Mailing Address - Fax:205-871-3339
Practice Address - Street 1:2045 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:SUITE 5-7
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6874
Practice Address - Country:US
Practice Address - Phone:205-870-7110
Practice Address - Fax:205-871-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL49361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU73195Medicare UPIN