Provider Demographics
NPI:1437596954
Name:NUNNALLY, ERIC NEEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:NEEL
Last Name:NUNNALLY
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 1:904 LILY CREEK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2816
Mailing Address - Country:US
Mailing Address - Phone:502-409-4299
Mailing Address - Fax:502-409-4309
Practice Address - Street 1:904 LILY CREEK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2816
Practice Address - Country:US
Practice Address - Phone:502-409-4299
Practice Address - Fax:502-409-4309
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY93051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice