MEDICARE: DR. AMY ELIZABETH NEALON DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	019.035957	IL
3	122300000X	Dentist	D-0007056-C1	AL

General Provider Information

NPI Number	:	1629713862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY ELIZABETH NEALON DMD

Provider Business Mailing Address
First Line	:	864 S RIVER RD
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6383
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 VETERANS MEMORIAL PKWY
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35404-5810
Country	:	US
Telephone Number	:	205-535-3205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2022
Last Update Date	:	05/28/2026

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