Provider Demographics
NPI:1700903762
Name:O'NEILL, KEVIN JAMES (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10 SIERRA GATE PLZ
Mailing Address - Street 2:SUITE #190
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6645
Mailing Address - Country:US
Mailing Address - Phone:916-786-3303
Mailing Address - Fax:916-786-3309
Practice Address - Street 1:10 SIERRA GATE PLZ
Practice Address - Street 2:SUITE #190
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6645
Practice Address - Country:US
Practice Address - Phone:916-786-3303
Practice Address - Fax:916-786-3309
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA259631223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics