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General NPI Number Information
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NPI Number | 1528001666
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Entity Type | Individual
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Provider Name | KEITH ALAN MELAAS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 25900 DEQUINDRE SUITE C
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City | WARREN
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State | MI
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Zip | 48091-6107
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Country | US
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Telephone | 586-756-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 3335 KNIARD
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City | OXFORD
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State | MI
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Zip | 48370-3027
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Country | US
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Telephone | 248-693-4399
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Fax | 248-814-7045
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 012929
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License Number State | MI
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