Individual provider Active NPI

Brian McNeely, DDS

  • General Practice Dentistry
  • Charlotte, NC
National Provider Identifier
1255536041
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8200 Issued in NC
Practice address
9550 Rocky River Rd Ste 202
Charlotte, NC 28215-9526
Phone
(704) 496-9001
Fax
(704) 496-9001
NPI assigned
Jun 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8200 NC Primary

Addresses

Primary practice location

9550 Rocky River Rd Ste 202
Charlotte, NC 28215-9526

Mailing address

9550 Rocky River Rd Ste 202
Charlotte, NC 28215-9526
Phone (704) 496-9001

Other identifiers 3

IdentifierTypeStateIssuer
822360OtherNCUNITED CONCORDIA
8990020MedicaidNC
90020OtherNCBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
8200NCMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
McNeely and Mallette DDS PA CurrentSince Jul 21, 2024 Accepting new patients
Brian K. McNeely, DDS, PA PastSince Jul 21, 2024 Accepting new patients
C. Clayton Walker, III, DDS, PA General Practice Past Accepting new patients

Locations

9550 Rocky River Rd
Ste 202
Charlotte, NC 28215
Phone (704) 496-9001

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1255536041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9550 ROCKY RIVER RD STE 202",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282159526",
            "telephone_number": "704-496-9001",
            "fax_number": "855-254-9601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9550 ROCKY RIVER RD STE 202",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282159526",
            "telephone_number": "704-496-9001",
            "fax_number": "704-496-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNEELY",
        "first_name": "BRIAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-20",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "8200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "822360",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8990020",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "90020",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.