Provider Demographics
NPI:1265474076
Name:O'NEIL, MICHAEL P (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
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 1:12953 PUBLISHERS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-8811
Mailing Address - Country:US
Mailing Address - Phone:317-849-2933
Mailing Address - Fax:317-849-2921
Practice Address - Street 1:12953 PUBLISHERS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-8811
Practice Address - Country:US
Practice Address - Phone:317-849-2933
Practice Address - Fax:317-849-2921
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120094131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12009413OtherSTATE LICENSE NUMBER