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General NPI Number Information
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NPI Number | 1710058672
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Entity Type | Individual
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Provider Name | WILLIAM RUSSELL NEAL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1434 SHELBY ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46203-1945
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Country | US
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Telephone | 317-655-3204
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Fax | 317-655-3223
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Provider Business Mailing Address
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Address Line | 4253 HONEYSUCKLE LN
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City | ZIONSVILLE
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State | IN
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Zip | 46077-8536
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Country | US
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Telephone | 317-513-2345
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Fax | 317-655-3223
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 12010663A
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License Number State | IN
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