Provider Demographics
NPI:1760533863
Name:NEILL, ROBERT A III (DDS PLLC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:NEILL
Suffix:III
Gender:M
Credentials:DDS PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 NELSON ISLAND LN
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:MT
Mailing Address - Zip Code:59421-8348
Mailing Address - Country:US
Mailing Address - Phone:065-606-0704
Mailing Address - Fax:
Practice Address - Street 1:44 NELSON ISLAND LN
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:MT
Practice Address - Zip Code:59421-8348
Practice Address - Country:US
Practice Address - Phone:065-606-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0130156Medicaid