Provider Demographics
NPI:1356441604
Name:MACNEIL, KEVIN JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:MACNEIL
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 1:5110 NW 59TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653
Mailing Address - Country:US
Mailing Address - Phone:352-376-6120
Mailing Address - Fax:
Practice Address - Street 1:DEPT. OF VETERANS AFFAIRS, NFSG, DENTAL SERVICES-160
Practice Address - Street 2:1601 SOUTHWEST ARCHER ROAD
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1911
Practice Address - Country:US
Practice Address - Phone:352-379-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00116381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice