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General NPI Number Information
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NPI Number | 1962747618
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Entity Type | Organization
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Legal Business Name | NEVILLS FAMILY DENTISTRY, PC
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 18540 SW VINCENT ST
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City | ALOHA
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State | OR
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Zip | 97078-1578
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Country | US
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Telephone | 503-649-3232
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Fax | 503-649-0362
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Provider Business Mailing Address
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Address Line | 18540 SW VINCENT ST
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City | ALOHA
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State | OR
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Zip | 97078-1578
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Country | US
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Telephone | 503-649-3232
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Fax | 503-649-0362
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID EUGENE NEVILLS
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Credential | DMD
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Telephone | 503-649-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D6095
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License Number State | OR
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