Provider Demographics
NPI:1699753996
Name:MC NEIL, ALLEN A (DDS, PC)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:A
Last Name:MC NEIL
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:ALLEN
Other - Middle Name:A
Other - Last Name:MC NEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:816 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-1462
Mailing Address - Country:US
Mailing Address - Phone:269-657-4458
Mailing Address - Fax:269-657-4482
Practice Address - Street 1:816 E MICHIGAN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-1462
Practice Address - Country:US
Practice Address - Phone:269-657-4458
Practice Address - Fax:269-657-4482
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0113301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID8000171-0OtherBCBS OF MICHIGAN ID