Provider Demographics
NPI:1841408457
Name:RICHARD J. NEAL JR., D.M.D. P.C.
Entity Type:Organization
Organization Name:RICHARD J. NEAL JR., D.M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-569-4119
Mailing Address - Street 1:P.O. BOX 1148
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO FALLS
Mailing Address - State:NH
Mailing Address - Zip Code:03896
Mailing Address - Country:US
Mailing Address - Phone:603-569-4119
Mailing Address - Fax:
Practice Address - Street 1:190 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894
Practice Address - Country:US
Practice Address - Phone:603-569-4119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30313494Medicaid