MEDICARE: DR. JOHN WOODWARD MCNEILL I D.D.S.

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	6064	NC

General Provider Information

NPI Number	:	1891863742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WOODWARD MCNEILL I D.D.S.

Provider Business Mailing Address
First Line	:	2020 FAIRVIEW RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27608-2316
Country	:	US
Telephone Number	:	919-821-2595
Fax Number	:	919-821-7816

Provider Business Practice Location Address
First Line	:	2020 FAIRVIEW RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27608-2316
Country	:	US
Telephone Number	:	919-821-2595
Fax Number	:	919-821-7816

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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