Provider Demographics
NPI:1851555247
Name:NEELY, MATTHEW A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:A
Last Name:NEELY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022832122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist