MEDICARE: DR. MICHAEL W. NEAL 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	DEA33640	CA

General Provider Information

NPI Number	:	1558370841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL W. NEAL DDS

Provider Business Mailing Address
First Line	:	441 MARCH AVE STE B
Second Line	:
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-3363
Country	:	US
Telephone Number	:	707-433-6910
Fax Number	:	707-433-2479

Provider Business Practice Location Address
First Line	:	441 MARCH AVE STE B
Second Line	:
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-3363
Country	:	US
Telephone Number	:	707-433-6910
Fax Number	:	707-433-2479

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	03/16/2015

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