Provider Demographics
NPI:1518076223
Name:NEAL ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:NEAL ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ASSOCIATE
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD DDS
Authorized Official - Phone:425-825-7575
Mailing Address - Street 1:13131 120TH AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-825-7575
Mailing Address - Fax:425-825-5615
Practice Address - Street 1:13131 120TH AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-825-7575
Practice Address - Fax:425-825-5615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT60941Medicare UPIN