Healthcare Provider Details

I. General information

NPI: 1104934314
Provider Name (Legal Business Name): RONALD E NEAL D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 15TH AVE S
GREAT FALLS MT
59405-5246
US

IV. Provider business mailing address

2714 15TH AVE S
GREAT FALLS MT
59405-5246
US

V. Phone/Fax

Practice location:
  • Phone: 406-727-4322
  • Fax: 406-771-1516
Mailing address:
  • Phone: 406-727-4322
  • Fax: 406-771-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1907
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: