MEDICARE: DR. ALYSSA JEAN KELLER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901603111	MI

General Provider Information

NPI Number	:	1811822083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALYSSA JEAN KELLER DDS

Provider Business Mailing Address
First Line	:	5211 POINTE TREMBLE RD
Second Line	:
City	:	ALGONAC
State	:	MI
Zip	:	48001-4366
Country	:	US
Telephone Number	:	586-569-9537
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 HURON AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3770
Country	:	US
Telephone Number	:	810-989-4746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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