Provider Demographics
NPI:1891533691
Name:MCNEILL, JOHN WOODWARD JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WOODWARD
Last Name:MCNEILL
Suffix:JR
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 1:1532 CARR ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2302
Mailing Address - Country:US
Mailing Address - Phone:919-624-4414
Mailing Address - Fax:
Practice Address - Street 1:2020 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2316
Practice Address - Country:US
Practice Address - Phone:919-821-2595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC138181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice