| Michael E. Kellam Dmd, Pc | |
|
1064 Industrial Pkwy Saraland AL 36571-3720 | |
| (251) 675-8150 | |
| (251) 675-8152 |
| Full Name | Michael E. Kellam Dmd, Pc |
|---|---|
| Speciality | Dentist |
| Location | 1064 Industrial Pkwy, Saraland, Alabama |
| Authorized Official Name and Position | Michael E Kellam (DMD, PRACTICE OWNER) |
| Authorized Official Contact | 2516758150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael E. Kellam Dmd, Pc 1064 Industrial Pkwy Saraland AL 36571-3720 Ph: (251) 675-8150 | Michael E. Kellam Dmd, Pc 1064 Industrial Pkwy Saraland AL 36571-3720 Ph: (251) 675-8150 |
| NPI Number | 1750522041 |
|---|---|
| Provider Enumeration Date | 03/16/2009 |
| Last Update Date | 05/27/2009 |
| Medicare PECOS PAC ID | 7012217540 |
|---|---|
| Medicare Enrollment ID | O20151204001516 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750522041 | NPI | - | NPPES |
| 009937656 | Medicaid | AL | |
| 515-11923 | Other | AL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 5252 (Alabama) | Primary |
| Provider Name | Michael E Kellam |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1851491765 PECOS PAC ID: 0143391904 Enrollment ID: I20080623000096 |
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