Healthcare Provider Details

I. General information

NPI: 1841085925
Provider Name (Legal Business Name): NEAL GOVANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N 56TH PL UNIT 150
RIDGEFIELD WA
98642-3504
US

IV. Provider business mailing address

421 N PENNSYLVANIA ST APT 803
INDIANAPOLIS IN
46204-2395
US

V. Phone/Fax

Practice location:
  • Phone: 564-333-2353
  • Fax:
Mailing address:
  • Phone: 219-276-1467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDENT.DE.70004806
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12178
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: