Provider Demographics
NPI:1093592453
Name:NEIL, LORON ANTHONY PATRICK
Entity Type:Individual
Prefix:DR
First Name:LORON
Middle Name:ANTHONY PATRICK
Last Name:NEIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8791 ALTA DR STE 2089
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8574
Mailing Address - Country:US
Mailing Address - Phone:516-388-8354
Mailing Address - Fax:
Practice Address - Street 1:8685 W SAHARA AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5880
Practice Address - Country:US
Practice Address - Phone:702-996-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV77691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice