Provider Demographics
NPI:1497817902
Name:O'NEILL, TERRANCE MICHAEL (DMD)
Entity Type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:MICHAEL
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 CLEVELAND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1218
Mailing Address - Country:US
Mailing Address - Phone:651-698-3828
Mailing Address - Fax:651-698-0864
Practice Address - Street 1:670 CLEVELAND AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1218
Practice Address - Country:US
Practice Address - Phone:651-698-3828
Practice Address - Fax:651-698-0864
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND111191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice