Provider Demographics
NPI:1962747618
Name:NEVILLS FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:NEVILLS FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:NEVILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-649-3232
Mailing Address - Street 1:18540 SW VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97078-1578
Mailing Address - Country:US
Mailing Address - Phone:503-649-3232
Mailing Address - Fax:503-649-0362
Practice Address - Street 1:18540 SW VINCENT ST
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97078-1578
Practice Address - Country:US
Practice Address - Phone:503-649-3232
Practice Address - Fax:503-649-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD60951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty