Healthcare Provider Details

I. General information

NPI: 1912939372
Provider Name (Legal Business Name): NEAL EDWARD SURRETTE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SPRUCE ST
EAST MILLINOCKET ME
04430
US

IV. Provider business mailing address

1 SPRUCE ST
EAST MILLINOCKET ME
04430
US

V. Phone/Fax

Practice location:
  • Phone: 207-746-9353
  • Fax: 207-746-9516
Mailing address:
  • Phone: 207-746-9353
  • Fax: 207-746-9516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2768
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: