Provider Demographics
NPI:1285202002
Name:O'NEAL, MARLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALNUT COVE
Mailing Address - State:NC
Mailing Address - Zip Code:27052-9393
Mailing Address - Country:US
Mailing Address - Phone:336-591-4303
Mailing Address - Fax:
Practice Address - Street 1:1218 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT COVE
Practice Address - State:NC
Practice Address - Zip Code:27052-9393
Practice Address - Country:US
Practice Address - Phone:336-591-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC122471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice