Provider Demographics
NPI:1922107861
Name:NEELY, DONALD J (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:NEELY
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ALLEN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-2065
Mailing Address - Country:US
Mailing Address - Phone:603-643-1200
Mailing Address - Fax:603-643-9269
Practice Address - Street 1:7 ALLEN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2065
Practice Address - Country:US
Practice Address - Phone:603-643-1200
Practice Address - Fax:603-643-9269
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics