Provider Demographics
NPI:1922274216
Name:MCNEIL-AMORTEGUY, DDS, INC.
Entity Type:Organization
Organization Name:MCNEIL-AMORTEGUY, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEIL-AMORTEGUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-543-3016
Mailing Address - Street 1:225 N SANTA ROSA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1324
Mailing Address - Country:US
Mailing Address - Phone:805-543-3016
Mailing Address - Fax:805-543-3444
Practice Address - Street 1:225 N SANTA ROSA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1324
Practice Address - Country:US
Practice Address - Phone:805-543-3016
Practice Address - Fax:805-543-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA367898261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3059812OtherCALIFORNIA STATE FILING#: