Provider Demographics
NPI:1114045176
Name:HOWARD F. NEILSON DMD AND BARBARA L. NEILSON, DMD, PC
Entity Type:Organization
Organization Name:HOWARD F. NEILSON DMD AND BARBARA L. NEILSON, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEILSOM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-789-9400
Mailing Address - Street 1:301 W CHESTER PIKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4530
Mailing Address - Country:US
Mailing Address - Phone:610-789-9400
Mailing Address - Fax:610-789-2841
Practice Address - Street 1:301 W CHESTER PIKE
Practice Address - Street 2:SUITE 202
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4530
Practice Address - Country:US
Practice Address - Phone:610-789-9400
Practice Address - Fax:610-789-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021747L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty