Healthcare Provider Details

I. General information

NPI: 1447318746
Provider Name (Legal Business Name): MICHAEL DAVID NEAL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 RIVERWAY PLACE
BEDFORD NH
03110-6744
US

IV. Provider business mailing address

303 RIVERWAY PLACE
BEDFORD NH
03110-6744
US

V. Phone/Fax

Practice location:
  • Phone: 603-623-6639
  • Fax: 603-644-5398
Mailing address:
  • Phone: 603-623-6639
  • Fax: 603-644-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3001
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: