1487593745 NPI number — NEAL ORAL AND MAXILLOFACIAL SURGERY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487593745 NPI number — NEAL ORAL AND MAXILLOFACIAL SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEAL ORAL AND MAXILLOFACIAL SURGERY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487593745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11011 MERIDIAN AVE N STE 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98133-8967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-363-3010
Provider Business Mailing Address Fax Number:
206-363-3829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13131 120TH AVE NE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-3037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-825-7575
Provider Business Practice Location Address Fax Number:
425-825-5615
Provider Enumeration Date:
03/25/2026

Additional Information

Authorized Official

Authorized Official Last Name:
WILCOX
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
206-363-3010

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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