Provider Demographics
NPI:1396738241
Name:NEELLEY, CHRISTOPHER MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:NEELLEY
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 1:11803 GRANT RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4032
Mailing Address - Country:US
Mailing Address - Phone:281-374-9255
Mailing Address - Fax:
Practice Address - Street 1:11803 GRANT RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4032
Practice Address - Country:US
Practice Address - Phone:281-374-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11921OtherTX DENTAL LICENSE NUMBER