Healthcare Provider Details

I. General information

NPI: 1720154404
Provider Name (Legal Business Name): NEAL ORAL & MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY SUITE 1207
SEATTLE WA
98101
US

IV. Provider business mailing address

509 OLIVE WAY SUITE 1207
SEATTLE WA
98101
US

V. Phone/Fax

Practice location:
  • Phone: 206-621-9047
  • Fax: 206-624-4664
Mailing address:
  • Phone: 206-621-9047
  • Fax: 206-624-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. GOARIK GALIA LEORARD
Title or Position: ASSOCIATE
Credential: MD DDS
Phone: 206-621-9047