Provider Demographics
NPI:1902396674
Name:NEIL, KATY (DDS)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:NEIL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 BABCOCK BLVD E STE 130
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-9144
Mailing Address - Country:US
Mailing Address - Phone:763-276-1410
Mailing Address - Fax:763-276-1411
Practice Address - Street 1:405 BABCOCK BLVD E STE 130
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-9144
Practice Address - Country:US
Practice Address - Phone:763-276-1410
Practice Address - Fax:763-276-1411
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty