Healthcare Provider Details

I. General information

NPI: 1821186123
Provider Name (Legal Business Name): THOMAS E MCNEELY DDS MS APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 OLIVE ST SUITE 204
SHREVEPORT LA
71104-2246
US

IV. Provider business mailing address

745 OLIVE ST SUITE 204
SHREVEPORT LA
71104-2246
US

V. Phone/Fax

Practice location:
  • Phone: 318-226-9306
  • Fax: 318-221-0018
Mailing address:
  • Phone: 318-226-9306
  • Fax: 318-221-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2847
License Number StateLA

VIII. Authorized Official

Name: THOMAS EDWARD MCNEELY
Title or Position: OWNER PRESIDENT
Credential: DDS MS
Phone: 318-226-9306