Provider Demographics
NPI:1336286137
Name:O'NEAL, JOE DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:DEAN
Last Name:O'NEAL
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 1:1331 UNION AVE STE 1225
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-7551
Mailing Address - Country:US
Mailing Address - Phone:901-276-7314
Mailing Address - Fax:901-276-6028
Practice Address - Street 1:1331 UNION AVE STE 1225
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7551
Practice Address - Country:US
Practice Address - Phone:901-276-7314
Practice Address - Fax:901-276-6028
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1336286137OtherTENNCARE