Provider Demographics
NPI:1104094226
Name:NEUSEL, EDWARD A (DDS)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:NEUSEL
Suffix:
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 1:14 PASCAL LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-3203
Mailing Address - Country:US
Mailing Address - Phone:512-382-1406
Mailing Address - Fax:
Practice Address - Street 1:215 E AVENUE G
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-4141
Practice Address - Country:US
Practice Address - Phone:409-385-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry