Provider Demographics
NPI:1760034144
Name:NEILL, CODY ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:ALAN
Last Name:NEILL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 BANNING ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7505
Mailing Address - Country:US
Mailing Address - Phone:910-224-1655
Mailing Address - Fax:
Practice Address - Street 1:1123 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7101
Practice Address - Country:US
Practice Address - Phone:843-402-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10047122300000X
FL24317122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist