Healthcare Provider Details

I. General information

NPI: 1235352733
Provider Name (Legal Business Name): JOSEPH ROBERT ONEIL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE PRIMARY CARE 186
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

305 W 12TH AVE PRIMARY CARE 186
COLUMBUS OH
43210-1267
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-2994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number30-01-2295
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: