Provider Demographics
NPI:1366693871
Name:NEELY DENTAL CLINIC, P.C.
Entity Type:Organization
Organization Name:NEELY DENTAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:NEELY
Authorized Official - Last Name:OVERSTREET
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-849-3636
Mailing Address - Street 1:600 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-3929
Mailing Address - Country:US
Mailing Address - Phone:601-849-3636
Mailing Address - Fax:601-849-2644
Practice Address - Street 1:600 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3929
Practice Address - Country:US
Practice Address - Phone:601-849-3636
Practice Address - Fax:601-849-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty