Provider Demographics
NPI:1730217019
Name:NEALE, WILLIAM D (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:NEALE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:21 PARADISE POINT RD
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1019
Mailing Address - Country:US
Mailing Address - Phone:850-609-0419
Mailing Address - Fax:
Practice Address - Street 1:824 EGLIN PKWY NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2530
Practice Address - Country:US
Practice Address - Phone:850-244-3880
Practice Address - Fax:850-243-7438
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 105841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics