Provider Demographics
NPI:1366646663
Name:CHARLES KEITH NEAVILLE JR
Entity Type:Organization
Organization Name:CHARLES KEITH NEAVILLE JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAHARLES
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:NEAVILLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-268-3332
Mailing Address - Street 1:1901 E BEEBE CAPPS EXPY
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6973
Mailing Address - Country:US
Mailing Address - Phone:501-268-3332
Mailing Address - Fax:501-268-1420
Practice Address - Street 1:1901 E BEEBE CAPPS EXPY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6973
Practice Address - Country:US
Practice Address - Phone:501-268-3332
Practice Address - Fax:501-268-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty