Provider Demographics
NPI:1730114950
Name:ONEILL, BOB L (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOB
Middle Name:L
Last Name:ONEILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:11971 IRON BRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831
Mailing Address - Country:US
Mailing Address - Phone:804-717-5275
Mailing Address - Fax:804-748-4017
Practice Address - Street 1:11971 IRON BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831
Practice Address - Country:US
Practice Address - Phone:804-717-5275
Practice Address - Fax:804-748-4017
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA46851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
086223OtherANTHEM BCBS
005298OtherANTHEM BCBS
005299OtherANTHEM BCBS
619201OtherUNITED CONCORDIA
619201OtherUNITED CONCORDIA