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General NPI Number Information
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NPI Number | 1386859338
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Entity Type | Individual
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Provider Name | JOHN C. O'NEILL D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 760 KINDERKAMACK RD
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City | RIVER EDGE
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State | NJ
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Zip | 07661-2447
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Country | US
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Telephone | 201-261-1522
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Fax |
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Provider Business Mailing Address
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Address Line | 164 ADAMS AVE
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City | RIVER EDGE
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State | NJ
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Zip | 07661-2232
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Country | US
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Telephone | 201-967-8960
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | NJ
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