Healthcare Provider Details

I. General information

NPI: 1265474076
Provider Name (Legal Business Name): MICHAEL P. O'NEIL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12953 PUBLISHERS DR SUITE 100
FISHERS IN
46038-8811
US

IV. Provider business mailing address

12953 PUBLISHERS DR SUITE 100
FISHERS IN
46038-8811
US

V. Phone/Fax

Practice location:
  • Phone: 317-849-2933
  • Fax: 317-849-2921
Mailing address:
  • Phone: 317-849-2933
  • Fax: 317-849-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12009413
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: