Provider Demographics
NPI:1063545713
Name:NEALIS, NEAL CHARLES JR (DDS)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:CHARLES
Last Name:NEALIS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E ERIE ST
Mailing Address - Street 2:SUITE #812
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2926
Mailing Address - Country:US
Mailing Address - Phone:312-266-9487
Mailing Address - Fax:
Practice Address - Street 1:233 E ERIE ST
Practice Address - Street 2:SUITE #812
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2926
Practice Address - Country:US
Practice Address - Phone:312-266-9487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA19-167621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice