Provider Demographics
NPI:1669684692
Name:MORTON-NEELY, MARVA MICHELENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARVA
Middle Name:MICHELENE
Last Name:MORTON-NEELY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25570 RANCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-1165
Mailing Address - Country:US
Mailing Address - Phone:248-478-0543
Mailing Address - Fax:
Practice Address - Street 1:19015 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-4005
Practice Address - Country:US
Practice Address - Phone:313-538-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010175861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice