Provider Demographics
NPI:1598116436
Name:BRIAN K. MCNEELY, DDS, PA
Entity Type:Organization
Organization Name:BRIAN K. MCNEELY, DDS, PA
Other - Org Name:MCNEELY FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEELY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-496-9001
Mailing Address - Street 1:9550 ROCKY RIVER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-9592
Mailing Address - Country:US
Mailing Address - Phone:704-496-9001
Mailing Address - Fax:
Practice Address - Street 1:9550 ROCKY RIVER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-9592
Practice Address - Country:US
Practice Address - Phone:704-496-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty