Keith A. Nalley, DDS, MS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2901014734 Issued in MI

Practice address

919 S Beechtree St
Suite 8
Grand Haven, MI 49417-2384

Phone

(616) 844-5135

Fax

(616) 844-5181

NPI assigned

Nov 22, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Sep 20, 2024 through Sep 20, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284076800000",
    "number": "1528041605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 S BEECHTREE ST",
            "address_2": "SUITE 8",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172384",
            "telephone_number": "616-844-5135",
            "fax_number": "616-844-5181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 S BEECHTREE ST",
            "address_2": "SUITE 8",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172384",
            "telephone_number": "616-844-5135",
            "fax_number": "616-844-5181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NALLEY",
        "first_name": "KEITH",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-22",
        "last_updated": "2010-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901014734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "2901014734",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Grand Haven, MI
• Providers in Grand Haven, MI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.