Provider Demographics
NPI:1366567752
Name:NEEL, JANET R (DDS)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:R
Last Name:NEEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 ELLSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7905
Mailing Address - Country:US
Mailing Address - Phone:719-579-9656
Mailing Address - Fax:
Practice Address - Street 1:6436 HWY 85/87 SUITE C
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817
Practice Address - Country:US
Practice Address - Phone:719-392-5111
Practice Address - Fax:719-392-4143
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98605712Medicaid