Provider Demographics
NPI:1821186123
Name:THOMAS E MCNEELY DDS MS APC
Entity Type:Organization
Organization Name:THOMAS E MCNEELY DDS MS APC
Other - Org Name:TOM MCNEELY DDS MS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MCNEELY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:318-226-9306
Mailing Address - Street 1:745 OLIVE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2246
Mailing Address - Country:US
Mailing Address - Phone:318-226-9306
Mailing Address - Fax:318-221-0018
Practice Address - Street 1:745 OLIVE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2246
Practice Address - Country:US
Practice Address - Phone:318-226-9306
Practice Address - Fax:318-221-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA28471223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty