Provider Demographics
NPI:1922103811
Name:MCNEELY, WILLIAM DEXTER (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DEXTER
Last Name:MCNEELY
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 1:8045 S LOGAN DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2835
Mailing Address - Country:US
Mailing Address - Phone:303-888-0309
Mailing Address - Fax:
Practice Address - Street 1:1880 S PIERCE ST STE 16B
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-7143
Practice Address - Country:US
Practice Address - Phone:303-922-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1057141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841286135OtherTIN#