Active NPI
J. Christian Neeley, D.D.S.
- Pediatric Dentistry
- New Haven, CT
National Provider Identifier
1932399391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 6654241
- Practice address
- 20 York St # T-209
New Haven, CT 06510-3220 - Phone
- (203) 688-3000
- Fax
- (203) 688-3050
- NPI assigned
- Jul 31, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6654241 | UT | |
| Student in an Organized Health Care Education/Training Program | 390200000X | AY2629155 | CT | |
| Pediatric Dentistry | 1223P0221X | 6654241 | UT | Primary |
Addresses
Primary practice location
20 York St # T-209
New Haven, CT 06510-3220
Mailing address
20 York St # T-209
New Haven, CT 06510-3220
Phone (203) 688-3000
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
| License | State | Type | Specialty |
|---|---|---|---|
| AY2629155 | CT | MD | Dentist |
| 6654241 | UT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672272000000",
"number": "1932399391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 YORK ST # T-209",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065103220",
"telephone_number": "203-688-3000",
"fax_number": "203-688-3050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 YORK ST # T-209",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065103220",
"telephone_number": "203-688-3000",
"fax_number": "203-688-3050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEELEY",
"first_name": "J. CHRISTIAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-31",
"last_updated": "2022-12-29",
"certification_date": "2022-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "UT",
"license": "6654241",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CT",
"license": "AY2629155",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Pediatric Dentistry",
"state": "UT",
"license": "6654241",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.