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General NPI Number Information
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NPI Number | 1649481755
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Entity Type | Individual
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Provider Name | ANTHONY LERON NEELY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 02/16/2009
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Provider Practice Location Address
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Address Line | 23077 GREENFIELD RD SUITE 285
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3709
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Country | US
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Telephone | 248-395-9800
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Fax | 248-395-9778
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Provider Business Mailing Address
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Address Line | 25570 RANCHWOOD DR
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City | FARMINGTON HILLS
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State | MI
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Zip | 48335-1165
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Country | US
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Telephone | 248-478-0543
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2901017558
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License Number State | MI
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