Provider Demographics
NPI:1558624973
Name:O'NEIL, MARJORIE HANNON (DMD)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:HANNON
Last Name:O'NEIL
Suffix:
Gender:F
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:PO BOX 2867
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36652-2867
Mailing Address - Country:US
Mailing Address - Phone:251-690-8158
Mailing Address - Fax:251-544-2188
Practice Address - Street 1:4547 SAINT STEPHENS RD
Practice Address - Street 2:
Practice Address - City:EIGHT MILE
Practice Address - State:AL
Practice Address - Zip Code:36613-3563
Practice Address - Country:US
Practice Address - Phone:251-456-1399
Practice Address - Fax:251-456-0079
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLNO 59291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630000013Medicaid
AL011846OtherMEDICARE GROUP NUMBER
AL1063439065OtherPAYEE NPI GROUP NUMBER