Healthcare Provider Details

I. General information

NPI: 1710126768
Provider Name (Legal Business Name): JACK M. NEAGLE JR., DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2009
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 W WHITE OAK TER STE C
CONROE TX
77304-3456
US

IV. Provider business mailing address

1805 W WHITE OAK TER STE C
CONROE TX
77304-3456
US

V. Phone/Fax

Practice location:
  • Phone: 936-539-2980
  • Fax: 936-539-2969
Mailing address:
  • Phone: 936-539-2980
  • Fax: 936-539-2969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number22205
License Number StateTX

VIII. Authorized Official

Name: LISA ANNE STEARNS
Title or Position: OFFICE MANAGER
Credential:
Phone: 936-539-2980