Provider Demographics
NPI:1609071232
Name:MCNEIL, KEVIN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:MCNEIL
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 1:10 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2413
Mailing Address - Country:US
Mailing Address - Phone:781-245-1593
Mailing Address - Fax:
Practice Address - Street 1:10 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2413
Practice Address - Country:US
Practice Address - Phone:781-245-1593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA145771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice