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General NPI Number Information
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NPI Number | 1841282027
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Entity Type | Individual
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Provider Name | BRIAN M O'NEILL DDS
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 970 W WOOSTER ST STE 126
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City | BOWLING GREEN
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State | OH
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Zip | 43402-2643
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Country | US
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Telephone | 419-353-2100
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Fax | 419-353-6606
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Provider Business Mailing Address
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Address Line | 4646 NANTUCKET DR STE A
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City | TOLEDO
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State | OH
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Zip | 43623-3194
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Country | US
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Telephone | 419-843-2121
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Fax | 419-517-2104
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 30-02-1069
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License Number State | OH
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