Provider Demographics
NPI:1881638989
Name:MCNEILL, ROBERT G (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:MCNEILL
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 PURDUE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-7721
Mailing Address - Country:US
Mailing Address - Phone:972-272-8751
Mailing Address - Fax:972-272-8752
Practice Address - Street 1:1530 FOREST LN S
Practice Address - Street 2:STE D
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-7950
Practice Address - Country:US
Practice Address - Phone:972-272-8751
Practice Address - Fax:972-272-8752
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1732729-01Medicaid
TX00354YMedicare ID - Type Unspecified
TXI25483Medicare UPIN