Provider Demographics
NPI:1063700193
Name:NEAL, TREVOR (DMD)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:NEAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5260 S ULSTER ST APT 3225
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2874
Mailing Address - Country:US
Mailing Address - Phone:720-401-8149
Mailing Address - Fax:
Practice Address - Street 1:8211 S HOLLY ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-4003
Practice Address - Country:US
Practice Address - Phone:303-290-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2012-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-10478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist