Healthcare Provider Details

I. General information

NPI: 1144274051
Provider Name (Legal Business Name): NEIL EVANS MOREY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 W 6TH ST, BLDG 440 US ARMY DENTAL ACTIVITY
FORT STEWART GA
31314-0001
US

IV. Provider business mailing address

351 W 6TH ST, BLDG 440, US ARMY DENTAL ACTIVITY (ATTN NANCY POSEY)
FORT STEWART GA
31314-0001
US

V. Phone/Fax

Practice location:
  • Phone: 912-767-6735
  • Fax: 520-533-7285
Mailing address:
  • Phone: 912-767-6735
  • Fax: 706-787-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7028
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7028
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: