Provider Demographics
NPI:1538832340
Name:NEELEY DENTAL LLC
Entity type:Organization
Organization Name:NEELEY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:NEELEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-774-1149
Mailing Address - Street 1:265 COLLEGE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2744
Mailing Address - Country:US
Mailing Address - Phone:724-774-1149
Mailing Address - Fax:724-774-9466
Practice Address - Street 1:265 COLLEGE AVE STE 1
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2744
Practice Address - Country:US
Practice Address - Phone:724-774-1149
Practice Address - Fax:724-774-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental