MEDICARE: DR. GREGG F MCNEAL DDS

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	1223G0001X	General Practice Dentistry	DN 000 9514	FL

General Provider Information

NPI Number	:	1528126984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGG F MCNEAL DDS

Provider Business Mailing Address
First Line	:	643 CAPE CORAL PKWY E
Second Line	:	#A
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-8549
Country	:	US
Telephone Number	:	239-542-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	643 CAPE CORAL PKWY E
Second Line	:	#A
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-8549
Country	:	US
Telephone Number	:	239-542-1800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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