Provider Demographics
NPI:1174631378
Name:NEVILLE, NICHOLAS L (DDS,MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:L
Last Name:NEVILLE
Suffix:
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6538 BOB O LINK DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3135
Mailing Address - Country:US
Mailing Address - Phone:214-823-3917
Mailing Address - Fax:
Practice Address - Street 1:5706 E MOCKINGBIRD LN STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5400
Practice Address - Country:US
Practice Address - Phone:214-821-0907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169841223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics