Provider Demographics
NPI:1801455720
Name:MOREAU, NEIL DAVID (RDH)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:DAVID
Last Name:MOREAU
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-5032
Mailing Address - Country:US
Mailing Address - Phone:413-222-2500
Mailing Address - Fax:
Practice Address - Street 1:230 MAPLE ST STE 4
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5143
Practice Address - Country:US
Practice Address - Phone:413-420-2200
Practice Address - Fax:413-420-2250
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH89754124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist