Healthcare Provider Details

I. General information

NPI: 1124367040
Provider Name (Legal Business Name): ELAINE M NEAL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 LYME RD SUITE 3
HANOVER NH
03755-1207
US

IV. Provider business mailing address

73 LYME RD SUITE 3
HANOVER NH
03755-1207
US

V. Phone/Fax

Practice location:
  • Phone: 603-643-3509
  • Fax: 603-643-3597
Mailing address:
  • Phone: 603-643-3509
  • Fax: 603-643-3597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2292
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: