Provider Demographics
NPI:1720154404
Name:NEAL ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:NEAL ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:DR
Authorized Official - First Name:GOARIK
Authorized Official - Middle Name:GALIA
Authorized Official - Last Name:LEORARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD DDS
Authorized Official - Phone:206-621-9047
Mailing Address - Street 1:509 OLIVE WAY
Mailing Address - Street 2:SUITE 1207
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101
Mailing Address - Country:US
Mailing Address - Phone:206-621-9047
Mailing Address - Fax:206-624-4664
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:SUITE 1207
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101
Practice Address - Country:US
Practice Address - Phone:206-621-9047
Practice Address - Fax:206-624-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT60941Medicare UPIN