=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407982218
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN A MCNEELEY DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 NORTH ABBE RD
-----------------------------------------------------
City | ELYRIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-365-0230
-----------------------------------------------------
Fax | 440-365-9557
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 N ABBE RD
-----------------------------------------------------
City | ELYRIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-365-0230
-----------------------------------------------------
Fax | 440-365-9557
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 18128
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------