Provider Demographics
NPI:1417113259
Name:O'SHAUGHNESSY, NEAL BURTON JR (DDS)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:BURTON
Last Name:O'SHAUGHNESSY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 TOWER AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-2532
Mailing Address - Country:US
Mailing Address - Phone:715-392-6213
Mailing Address - Fax:715-392-4631
Practice Address - Street 1:1507 TOWER AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2532
Practice Address - Country:US
Practice Address - Phone:715-392-6213
Practice Address - Fax:715-392-4631
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4337-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice