Provider Demographics
NPI:1124387535
Name:MCNIEL, JOSEPH C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:MCNIEL
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 1:250 N GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2285
Mailing Address - Country:US
Mailing Address - Phone:920-725-7840
Mailing Address - Fax:920-725-5355
Practice Address - Street 1:250 N GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2285
Practice Address - Country:US
Practice Address - Phone:920-725-7840
Practice Address - Fax:920-725-5355
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI6889-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program