Provider Demographics
NPI:1225248743
Name:NEELY, ANGIE DAWN
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:DAWN
Last Name:NEELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-2300
Mailing Address - Country:US
Mailing Address - Phone:541-756-9238
Mailing Address - Fax:541-756-9617
Practice Address - Street 1:2000 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2300
Practice Address - Country:US
Practice Address - Phone:541-756-9238
Practice Address - Fax:541-756-9617
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant