Provider Demographics
NPI:1083960397
Name:NEIL, DONNA T
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:T
Last Name:NEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 JADE DR
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-1361
Mailing Address - Country:US
Mailing Address - Phone:508-801-9799
Mailing Address - Fax:
Practice Address - Street 1:22 JADE DR
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1361
Practice Address - Country:US
Practice Address - Phone:508-801-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH5986124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist