Provider Demographics
NPI:1073594222
Name:NEELY, JOHN F (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:NEELY
Suffix:
Gender:M
Credentials:DMD
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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
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76781223P0106X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902UXMedicaid
NCU99539Medicare UPIN
NC89902UXMedicaid