Provider Demographics
NPI:1902969629
Name:NEELY, MONICA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:M
Last Name:NEELY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10900 HEFNER POINTE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5082
Mailing Address - Country:US
Mailing Address - Phone:405-302-0100
Mailing Address - Fax:405-302-0105
Practice Address - Street 1:10900 HEFNER POINTE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5082
Practice Address - Country:US
Practice Address - Phone:405-302-0100
Practice Address - Fax:405-302-0105
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK53831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice