Provider Demographics
NPI:1508972837
Name:O'NEIL, DEANNA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:LYNN
Last Name:O'NEIL
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 1:103 S EDDY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-3101
Mailing Address - Country:US
Mailing Address - Phone:574-288-4400
Mailing Address - Fax:
Practice Address - Street 1:103 S EDDY ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-3101
Practice Address - Country:US
Practice Address - Phone:574-288-4400
Practice Address - Fax:574-288-5437
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50260151223P0221X
IN12011222A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry