Provider Demographics
NPI:1730228271
Name:MCNEILL, KELLY MCENTIRE (RDH)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MCENTIRE
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12506 ATKINS CIRCLE DR
Mailing Address - Street 2:APT 112
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0037
Mailing Address - Country:US
Mailing Address - Phone:980-721-8974
Mailing Address - Fax:
Practice Address - Street 1:11535 CARMEL COMMONS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5313
Practice Address - Country:US
Practice Address - Phone:704-540-2443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7893124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist