Provider Demographics
NPI:1689809667
Name:MCNEELY, GARY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:W
Last Name:MCNEELY
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:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:IA
Mailing Address - Zip Code:50851-0126
Mailing Address - Country:US
Mailing Address - Phone:641-536-2121
Mailing Address - Fax:641-536-2121
Practice Address - Street 1:108 1/2 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:IA
Practice Address - Zip Code:50851-0126
Practice Address - Country:US
Practice Address - Phone:641-536-2121
Practice Address - Fax:641-536-2121
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice