Provider Demographics
NPI:1558876599
Name:KEVIN K ONEILL DDS PC
Entity Type:Organization
Organization Name:KEVIN K ONEILL DDS PC
Other - Org Name:HOMESTEAD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ONEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-913-4042
Mailing Address - Street 1:561 DEER MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80124-9712
Mailing Address - Country:US
Mailing Address - Phone:303-913-4042
Mailing Address - Fax:303-224-9456
Practice Address - Street 1:6990 S HOLLY CIR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1018
Practice Address - Country:US
Practice Address - Phone:303-224-9400
Practice Address - Fax:303-224-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1056731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty