Provider Demographics
NPI:1184638801
Name:O'NEIL, SCOTT R (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
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 1:205 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-1940
Mailing Address - Country:US
Mailing Address - Phone:402-873-5059
Mailing Address - Fax:
Practice Address - Street 1:205 N 13TH ST
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-1940
Practice Address - Country:US
Practice Address - Phone:402-873-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE56021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-0722311-00Medicaid