Provider Demographics
NPI:1053482471
Name:NEAL, PHILLIP CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:CHARLES
Last Name:NEAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MEMORIAL CT STE B
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6233
Mailing Address - Country:US
Mailing Address - Phone:815-459-2202
Mailing Address - Fax:815-459-2787
Practice Address - Street 1:280 MEMORIAL CT STE B
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6233
Practice Address - Country:US
Practice Address - Phone:815-459-2202
Practice Address - Fax:815-459-2787
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice