Provider Demographics
NPI:1295817666
Name:NEAL, RICHARD JORDAN JR (DMD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JORDAN
Last Name:NEAL
Suffix:JR
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 1:190 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO FALLS
Mailing Address - State:NH
Mailing Address - Zip Code:03896
Mailing Address - Country:US
Mailing Address - Phone:603-569-4119
Mailing Address - Fax:603-569-8605
Practice Address - Street 1:190 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:WOLFEBORO FALLS
Practice Address - State:NH
Practice Address - Zip Code:03896
Practice Address - Country:US
Practice Address - Phone:603-569-4119
Practice Address - Fax:603-569-8605
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1863122300000X
ME3779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AN2270332OtherDEA
AN2270332OtherDEA