Provider Demographics
NPI:1265551113
Name:O'NEAL, STEVEN BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BRUCE
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2230 TOWNE LAKE PKWY
Mailing Address - Street 2:BLDG. 100, SUITE 100
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5540
Mailing Address - Country:US
Mailing Address - Phone:770-924-8848
Mailing Address - Fax:770-924-4467
Practice Address - Street 1:2230 TOWNE LAKE PKWY
Practice Address - Street 2:BLDG. 100, SUITE 100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5540
Practice Address - Country:US
Practice Address - Phone:770-924-8848
Practice Address - Fax:770-924-4467
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA85321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice