Provider Demographics
NPI:1134451982
Name:MCNEILL, SU (DMD)
Entity type:Individual
Prefix:DR
First Name:SU
Middle Name:
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 COLISEUM DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5903
Mailing Address - Country:US
Mailing Address - Phone:757-827-0250
Mailing Address - Fax:757-827-8839
Practice Address - Street 1:2240 COLISEUM DR
Practice Address - Street 2:SUITE F
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5903
Practice Address - Country:US
Practice Address - Phone:757-827-0250
Practice Address - Fax:757-827-8839
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412524122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist