Provider Demographics
NPI:1013012087
Name:O'NEIL, THOMAS R (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:O'NEIL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7707 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2950
Mailing Address - Country:US
Mailing Address - Phone:954-720-9570
Mailing Address - Fax:
Practice Address - Street 1:7707 N UNIVERSITY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2950
Practice Address - Country:US
Practice Address - Phone:954-720-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN105871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice