Healthcare Provider Details

I. General information

NPI: 1770503005
Provider Name (Legal Business Name): NEIL N MIGHALL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S 3RD ST
LA CRESCENT MN
55947-1329
US

IV. Provider business mailing address

406 S 3RD ST
LA CRESCENT MN
55947-1329
US

V. Phone/Fax

Practice location:
  • Phone: 507-895-6770
  • Fax:
Mailing address:
  • Phone: 507-895-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD8852
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5690-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: