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General NPI Number Information
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NPI Number | 1104094226
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Entity Type | Individual
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Provider Name | EDWARD A NEUSEL DDS
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Gender | Male
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 215 E AVENUE G
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City | SILSBEE
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State | TX
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Zip | 77656-4141
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Country | US
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Telephone | 409-385-3651
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Fax |
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Provider Business Mailing Address
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Address Line | 14 PASCAL LN
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City | AUSTIN
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State | TX
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Zip | 78746-3203
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Country | US
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Telephone | 512-382-1406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10828
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License Number State | TX
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