Provider Demographics
NPI:1760542443
Name:TREECE, NEILL HAMILTON (DDS PA)
Entity Type:Individual
Prefix:DR
First Name:NEILL
Middle Name:HAMILTON
Last Name:TREECE
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 NO 39TH
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72904
Mailing Address - Country:US
Mailing Address - Phone:479-783-4469
Mailing Address - Fax:479-783-1990
Practice Address - Street 1:1528 NO 39TH
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904
Practice Address - Country:US
Practice Address - Phone:479-783-4469
Practice Address - Fax:479-783-1990
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR19661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice