Provider Demographics
NPI:1164404943
Name:NEAL, ALAN KEITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KEITH
Last Name:NEAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9602 BALSA DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-3129
Mailing Address - Country:US
Mailing Address - Phone:318-798-0660
Mailing Address - Fax:
Practice Address - Street 1:1067 TWINING DR
Practice Address - Street 2:2ND DENTAL SQUADRON
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110-2486
Practice Address - Country:US
Practice Address - Phone:318-456-4018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0359301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice