Provider Demographics
NPI:1811421910
Name:NEELY, ANTHONY KYLE (DMD)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:KYLE
Last Name:NEELY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6643 HWY. 98
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8442
Mailing Address - Country:US
Mailing Address - Phone:601-450-6060
Mailing Address - Fax:601-450-6062
Practice Address - Street 1:6643 HWY. 98
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8442
Practice Address - Country:US
Practice Address - Phone:601-450-6060
Practice Address - Fax:601-450-6062
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3928-171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry