Provider Demographics
NPI:1770831166
Name:MATTHEW A NEELY DDS LLC
Entity Type:Organization
Organization Name:MATTHEW A NEELY DDS LLC
Other - Org Name:NEELY DENTAL TEAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-898-8798
Mailing Address - Street 1:39 DELLSING DR
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-1319
Mailing Address - Country:US
Mailing Address - Phone:937-898-8798
Mailing Address - Fax:937-898-1915
Practice Address - Street 1:39 DELLSING DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1319
Practice Address - Country:US
Practice Address - Phone:937-898-8798
Practice Address - Fax:937-898-1915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0228321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty