Healthcare Provider Details

I. General information

NPI: 1811822083
Provider Name (Legal Business Name): ALYSSA JEAN KELLER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 HURON AVE
PORT HURON MI
48060-3770
US

IV. Provider business mailing address

5211 POINTE TREMBLE RD
ALGONAC MI
48001-4366
US

V. Phone/Fax

Practice location:
  • Phone: 810-989-4746
  • Fax:
Mailing address:
  • Phone: 586-569-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603111
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: