Healthcare Provider Details

I. General information

NPI: 1710972567
Provider Name (Legal Business Name): JOHN MCNEILL DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E 30TH ST BLDG 2
FARMINGTON NM
87401-8986
US

IV. Provider business mailing address

2401 E 30TH ST BLDG 2
FARMINGTON NM
87401-8986
US

V. Phone/Fax

Practice location:
  • Phone: 505-326-2611
  • Fax: 505-326-5152
Mailing address:
  • Phone: 505-326-2611
  • Fax: 505-326-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1123
License Number StateNM

VIII. Authorized Official

Name: DR. JOHN A MCNEILL
Title or Position: PRES
Credential: DDS
Phone: 505-326-2611