Provider Demographics
NPI:1477927572
Name:NEAL DENTAL GROUP
Entity Type:Organization
Organization Name:NEAL DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-600-0786
Mailing Address - Street 1:4407 BEE CAVES RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6405
Mailing Address - Country:US
Mailing Address - Phone:512-600-0786
Mailing Address - Fax:512-600-0781
Practice Address - Street 1:4407 BEE CAVES RD
Practice Address - Street 2:SUITE 302
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6405
Practice Address - Country:US
Practice Address - Phone:512-600-0786
Practice Address - Fax:512-600-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty