Provider Demographics
NPI:1043464035
Name:IRION, NEAL (DT)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:IRION
Suffix:
Gender:M
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8960 SPRINGBROOK DR NW
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5852
Mailing Address - Country:US
Mailing Address - Phone:763-784-7570
Mailing Address - Fax:763-785-8960
Practice Address - Street 1:8960 SPRINGBROOK DR NW
Practice Address - Street 2:SUITE 150
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5852
Practice Address - Country:US
Practice Address - Phone:763-784-7570
Practice Address - Fax:763-785-8960
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH6853124Q00000X
MNDT73125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist
No124Q00000XDental ProvidersDental Hygienist