Provider Demographics
NPI:1659596088
Name:DAVID C NEAL DDS PA
Entity Type:Organization
Organization Name:DAVID C NEAL DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:863-294-7648
Mailing Address - Street 1:400 AVENUE K SE
Mailing Address - Street 2:SUITE #10
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4145
Mailing Address - Country:US
Mailing Address - Phone:863-294-7648
Mailing Address - Fax:863-294-9045
Practice Address - Street 1:400 AVENUE K SE
Practice Address - Street 2:SUITE #10
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4145
Practice Address - Country:US
Practice Address - Phone:863-294-7648
Practice Address - Fax:863-294-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00052731223S0112X
FLDN152791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T55244Medicare UPIN
FLK2050Medicare ID - Type Unspecified