Provider Demographics
NPI:1881323004
Name:O'NEILL, THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 BLUE HERON CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9416
Mailing Address - Country:US
Mailing Address - Phone:803-319-0466
Mailing Address - Fax:
Practice Address - Street 1:244 S MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30453-4602
Practice Address - Country:US
Practice Address - Phone:912-557-6307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist