Healthcare Provider Details

I. General information

NPI: 1053691378
Provider Name (Legal Business Name): STEVEN ALAN NEVILLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MAIN ST NE
BONDURANT IA
50035-7722
US

IV. Provider business mailing address

1104 15TH ST SE
BONDURANT IA
50035-4427
US

V. Phone/Fax

Practice location:
  • Phone: 515-967-4002
  • Fax: 515-967-4003
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number08866
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: