Provider Demographics
NPI:1760084826
Name:LARRY J ONEILL DMD PC
Entity Type:Organization
Organization Name:LARRY J ONEILL DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ONEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-646-3935
Mailing Address - Street 1:779 CROSSROADS CR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-2466
Mailing Address - Country:US
Mailing Address - Phone:303-646-3935
Mailing Address - Fax:303-379-5380
Practice Address - Street 1:779 CROSSROADS CIRCLE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107-2466
Practice Address - Country:US
Practice Address - Phone:720-646-3935
Practice Address - Fax:303-379-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386905057OtherNPPES
1760084826OtherNPPES