Provider Demographics
NPI:1578546552
Name:ONEIL, JEFFREY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:E
Last Name:ONEIL
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 1:6945 PENN AVE S
Mailing Address - Street 2:STE 101
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2082
Mailing Address - Country:US
Mailing Address - Phone:612-866-2233
Mailing Address - Fax:612-866-2341
Practice Address - Street 1:6945 PENN AVE S
Practice Address - Street 2:STE 101
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2063
Practice Address - Country:US
Practice Address - Phone:612-866-2233
Practice Address - Fax:612-866-2341
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN140357500Medicaid