Provider Demographics
NPI:1952510471
Name:NEIL, ROBIN R (DMD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:R
Last Name:NEIL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 1ST AVE N STE 212
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2502
Mailing Address - Country:US
Mailing Address - Phone:406-454-1512
Mailing Address - Fax:
Practice Address - Street 1:503 1ST AVE N STE 212
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2502
Practice Address - Country:US
Practice Address - Phone:406-454-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT110552Medicaid