Healthcare Provider Details

I. General information

NPI: 1205933108
Provider Name (Legal Business Name): MICHAEL LETEFF O'NEIL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21701 76TH AVE W SUITE #202
EDMONDS WA
98026-7536
US

IV. Provider business mailing address

21701 76TH AVE W SUITE #202
EDMONDS WA
98026-7536
US

V. Phone/Fax

Practice location:
  • Phone: 425-744-1724
  • Fax: 425-744-1726
Mailing address:
  • Phone: 425-744-1724
  • Fax: 425-744-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE60330979
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: