Provider Demographics
NPI:1750602124
Name:NEALE, AARON MARTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:MARTIN
Last Name:NEALE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-4941
Mailing Address - Country:US
Mailing Address - Phone:918-960-4013
Mailing Address - Fax:
Practice Address - Street 1:1520 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-4941
Practice Address - Country:US
Practice Address - Phone:918-960-4013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK62041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice