Provider Demographics
NPI:1871679035
Name:NEAL B O'SHAUGHNESSY DDS LTD
Entity type:Organization
Organization Name:NEAL B O'SHAUGHNESSY DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:OSHAVGHNESSY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-392-6213
Mailing Address - Street 1:1507 TOWER AVENUE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-2532
Mailing Address - Country:US
Mailing Address - Phone:715-392-6213
Mailing Address - Fax:715-392-4631
Practice Address - Street 1:1507 TOWER AVENUE
Practice Address - Street 2:SUITE 410
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2532
Practice Address - Country:US
Practice Address - Phone:715-392-6213
Practice Address - Fax:715-392-4631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4337-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty