Healthcare Provider Details

I. General information

NPI: 1801925656
Provider Name (Legal Business Name): MICHAEL A. KELLER DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 BROOKWOOD MEDICAL CTR DR SUITE 5-7
BIRMINGHAM AL
35209-6874
US

IV. Provider business mailing address

2045 BROOKWOOD MEDICAL CTR DR SUITE 5-7
BIRMINGHAM AL
35209-6874
US

V. Phone/Fax

Practice location:
  • Phone: 205-870-7110
  • Fax: 205-871-3339
Mailing address:
  • Phone: 205-870-7110
  • Fax: 205-871-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4936
License Number StateAL

VIII. Authorized Official

Name: DR. MICHAEL AAON KELLER
Title or Position: PEDIATRIC DENTIST
Credential: DDS, PC
Phone: 205-870-7110