Provider Demographics
NPI:1477718146
Name:MCNEIL, JONATHAN CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CHRISTOPHER
Last Name:MCNEIL
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 1:3606 RHONE CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5049
Mailing Address - Country:US
Mailing Address - Phone:907-646-8670
Mailing Address - Fax:907-562-2170
Practice Address - Street 1:3606 RHONE CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5049
Practice Address - Country:US
Practice Address - Phone:907-646-8670
Practice Address - Fax:907-562-2170
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD91421223G0001X
AK13311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDDG045Medicaid