Provider Demographics
NPI:1255007266
Name:APPOMATTOX RIVER ORAL AND FACIAL SURGERY P.C.
Entity Type:Organization
Organization Name:APPOMATTOX RIVER ORAL AND FACIAL SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:804-732-6532
Mailing Address - Street 1:595 OLD WAGNER RD STE A
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9307
Mailing Address - Country:US
Mailing Address - Phone:804-732-6532
Mailing Address - Fax:804-861-8070
Practice Address - Street 1:595 OLD WAGNER RD STE A
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9307
Practice Address - Country:US
Practice Address - Phone:804-732-6532
Practice Address - Fax:804-861-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty