Provider Demographics
NPI:1013937929
Name:K. E. NEILL, JR. DDS LTD
Entity Type:Organization
Organization Name:K. E. NEILL, JR. DDS LTD
Other - Org Name:DRS NEILL AND NEILL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNEDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEILL
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-898-6832
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23690-0427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:219 COOK ROAD
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23690
Practice Address - Country:US
Practice Address - Phone:757-898-6832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA72701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty