Provider Demographics
NPI:1043243124
Name:JOHN F NEELY DMD PA
Entity Type:Organization
Organization Name:JOHN F NEELY DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:910-295-8088
Mailing Address - Street 1:93 AVIEMORE DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9797
Mailing Address - Country:US
Mailing Address - Phone:910-295-8088
Mailing Address - Fax:910-295-8855
Practice Address - Street 1:93 AVIEMORE DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9797
Practice Address - Country:US
Practice Address - Phone:910-295-8088
Practice Address - Fax:910-295-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1073594222OtherDR NEELY NPI INDIVIDUAL
NC1861473019OtherGARY T JONES DMD NPI
NCU99539Medicare UPIN