Provider Demographics
NPI:1538893185
Name:NEAL, AUSTIN DANIEL (DDS)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:DANIEL
Last Name:NEAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:AUSTIN
Other - Middle Name:DANIEL
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:10025 19TH AVE SE STE 200
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4275
Mailing Address - Country:US
Mailing Address - Phone:425-337-6885
Mailing Address - Fax:
Practice Address - Street 1:10025 19TH AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4275
Practice Address - Country:US
Practice Address - Phone:425-337-6885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE612938921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice