Provider Demographics
NPI:1285906008
Name:JEFFREY A NEAL DDS PC
Entity type:Organization
Organization Name:JEFFREY A NEAL DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-447-1435
Mailing Address - Street 1:2215 PUMP RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-3507
Mailing Address - Country:US
Mailing Address - Phone:804-447-1435
Mailing Address - Fax:804-447-3932
Practice Address - Street 1:2215 PUMP RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-3507
Practice Address - Country:US
Practice Address - Phone:804-447-1435
Practice Address - Fax:804-447-3932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008775122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty