Provider Demographics
NPI:1932399391
Name:NEELEY, J. CHRISTIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:J. CHRISTIAN
Middle Name:
Last Name:NEELEY
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 1:20 YORK ST # T-209
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-688-3000
Mailing Address - Fax:203-688-3050
Practice Address - Street 1:20 YORK ST # T-209
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-3000
Practice Address - Fax:203-688-3050
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT66542411223G0001X, 1223P0221X
CTAY2629155390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program