Provider Demographics
NPI:1558370841
Name:NEAL, MICHAEL W (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:NEAL
Suffix:
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 1:441 MARCH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3363
Mailing Address - Country:US
Mailing Address - Phone:707-433-6910
Mailing Address - Fax:707-433-2479
Practice Address - Street 1:441 MARCH AVE STE B
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3363
Practice Address - Country:US
Practice Address - Phone:707-433-6910
Practice Address - Fax:707-433-2479
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADEA336401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice