Provider Demographics
NPI:1447698667
Name:J NEAL DENTAL PC
Entity type:Organization
Organization Name:J NEAL DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:308-928-9010
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:NE
Mailing Address - Zip Code:68920-0807
Mailing Address - Country:US
Mailing Address - Phone:308-928-9010
Mailing Address - Fax:308-928-9031
Practice Address - Street 1:612 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:NE
Practice Address - Zip Code:68920
Practice Address - Country:US
Practice Address - Phone:308-928-9010
Practice Address - Fax:308-928-9031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J NEAL DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty