MEDICARE: MICHAEL J NEELEY DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1295376788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL J NEELEY DDS INC

Provider Business Mailing Address
First Line	:	9301 N CENTRAL EXPY STE 585
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-0811
Country	:	US
Telephone Number	:	214-521-3148
Fax Number	:	214-521-3186

Provider Business Practice Location Address
First Line	:	9301 N CENTRAL EXPY STE 585
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-0811
Country	:	US
Telephone Number	:	214-521-3148
Fax Number	:	214-521-3186

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL JOSEPH NEELEY
Credential	:	DDS
Telephone Number	:	214-521-3148

Provider Enumeration Date	:	10/05/2019
Last Update Date	:	10/05/2019

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