MEDICARE: DR. THOMAS O'NEILL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN122675	GA

General Provider Information

NPI Number	:	1881323004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS O'NEILL DMD

Provider Business Mailing Address
First Line	:	371 BLUE HERON CT
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-9416
Country	:	US
Telephone Number	:	803-319-0466
Fax Number	:

Provider Business Practice Location Address
First Line	:	244 S MAIN ST
Second Line	:
City	:	REIDSVILLE
State	:	GA
Zip	:	30453-4602
Country	:	US
Telephone Number	:	912-557-6307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2022
Last Update Date	:	06/06/2022

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