Individual
DR. KEITH A. NALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
919 S BEECHTREE ST, SUITE 8, GRAND HAVEN, MI 49417-2384
(616) 844-5135
(616) 844-5181
Mailing address
919 S BEECHTREE ST, SUITE 8, GRAND HAVEN, MI 49417-2384
(616) 844-5135
(616) 844-5181
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901014734
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2901014734
STATE LICENSE #
MI
Enumeration date
11/22/2005
Last updated
09/10/2010
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