Provider Demographics
NPI:1790918159
Name:NEIL, ADA S (DMD)
Entity Type:Individual
Prefix:MRS
First Name:ADA
Middle Name:S
Last Name:NEIL
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 1:3091 COLLEGE PARK DR.
Mailing Address - Street 2:SUITE # 310
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384
Mailing Address - Country:US
Mailing Address - Phone:936-321-2995
Mailing Address - Fax:
Practice Address - Street 1:615 NORTH LOOP E STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-5934
Practice Address - Country:US
Practice Address - Phone:832-581-3540
Practice Address - Fax:346-355-8882
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24973122300000X, 1223G0001X
TX11571124Q00000X
TX#249731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No124Q00000XDental ProvidersDental Hygienist