Healthcare Provider Details

I. General information

NPI: 1235655812
Provider Name (Legal Business Name): HUNTER NEILL DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 07/21/2022
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 LEESVILLE RD STE 160
RALEIGH NC
27613-7540
US

IV. Provider business mailing address

9201 LEESVILLE RD STE 160
RALEIGH NC
27613-7540
US

V. Phone/Fax

Practice location:
  • Phone: 919-844-8826
  • Fax:
Mailing address:
  • Phone: 919-844-8826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10427
License Number StateNC

VIII. Authorized Official

Name: HUNTER NEILL
Title or Position: ORTHODONTIST
Credential:
Phone: 919-844-8826