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General NPI Number Information
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NPI Number | 1710972567
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Entity Type | Organization
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Legal Business Name | JOHN MCNEILL DDS PC
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 2401 E 30TH ST BLDG 2
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City | FARMINGTON
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State | NM
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Zip | 87401-8986
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Country | US
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Telephone | 505-326-2611
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Fax | 505-326-5152
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Provider Business Mailing Address
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Address Line | 2401 E 30TH ST BLDG 2
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City | FARMINGTON
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State | NM
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Zip | 87401-8986
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Country | US
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Telephone | 505-326-2611
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Fax | 505-326-5152
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Authorized Official
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Title or Position | PRES
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Name | DR. JOHN A MCNEILL
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Credential | DDS
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Telephone | 505-326-2611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 1123
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License Number State | NM
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