Healthcare Provider Details

I. General information

NPI: 1760084826
Provider Name (Legal Business Name): LARRY J ONEILL DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 03/25/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

779 CROSSROADS CIRCLE
ELIZABETH CO
80107-2466
US

IV. Provider business mailing address

779 CROSSROADS CR
ELIZABETH CO
80107-2466
US

V. Phone/Fax

Practice location:
  • Phone: 720-646-3935
  • Fax: 303-379-5380
Mailing address:
  • Phone: 303-646-3935
  • Fax: 303-379-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LARRY J ONEILL
Title or Position: PRESIDENT
Credential: DMD
Phone: 303-646-3935