Organization
MICHAEL E. KELLAM DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL E KELLAM DMD (DMD, PRACTICE OWNER)
(251) 675-8150
Entity
Organization
Contact information
Practice address
1064 INDUSTRIAL PKWY, SARALAND, AL 36571-3720
(251) 675-8150
(251) 675-8152
Mailing address
1064 INDUSTRIAL PKWY, SARALAND, AL 36571-3720
(251) 675-8150
(251) 675-8152
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5252
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009937656
—
AL
01
—
515-11923
BLUE CROSS BLUE SHIELD
AL
Enumeration date
03/16/2009
Last updated
05/27/2009
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