MEDICARE: DR. MICHAEL JOSEPH NEELEY DDS

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	122300000X	Dentist	11206	TX

General Provider Information

NPI Number	:	1760493423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOSEPH NEELEY DDS

Provider Business Mailing Address
First Line	:	3131 HARVARD AVE
Second Line	:	SUITE 101
City	:	DALLAS
State	:	TX
Zip	:	75205-3443
Country	:	US
Telephone Number	:	214-521-3148
Fax Number	:	214-521-3186

Provider Business Practice Location Address
First Line	:	3131 HARVARD AVE
Second Line	:	SUITE 101
City	:	DALLAS
State	:	TX
Zip	:	75205-3443
Country	:	US
Telephone Number	:	214-521-3148
Fax Number	:	214-521-3186

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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