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General NPI Number Information
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NPI Number | 1508972837
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Entity Type | Individual
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Provider Name | DEANNA LYNN O'NEIL DDS
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Gender | Female
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 103 S EDDY ST
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City | SOUTH BEND
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State | IN
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Zip | 46617-3101
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Country | US
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Telephone | 574-288-4400
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Fax | 574-288-5437
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Provider Business Mailing Address
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Address Line | 103 S EDDY ST
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City | SOUTH BEND
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State | IN
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Zip | 46617-3101
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Country | US
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Telephone | 574-288-4400
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 5026015
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12011222A
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License Number State | IN
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