Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 1907 | MT |
NPI | 1104934314 |
---|---|
Provider Name | Dr. Ronald E Neal |
First Address | Great Falls, MT 59405-5246 |
Second Address | Great Falls, MT 59405-5246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1907 | DENTAL LICENSE NUMBER (01) | MT |
T78887 | (02) | MT |