Provider Demographics
NPI:1922009158
Name:O'NEAL, DAVID GLENN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GLENN
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6188 OXON HILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3157
Mailing Address - Country:US
Mailing Address - Phone:301-567-3122
Mailing Address - Fax:301-567-5234
Practice Address - Street 1:6188 OXON HILL RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3113
Practice Address - Country:US
Practice Address - Phone:301-567-3122
Practice Address - Fax:301-567-5234
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD108441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice