Provider Demographics
NPI:1194980284
Name:KEVIN J. O'NEILL, D.D.S., M.S.D., INC.
Entity type:Organization
Organization Name:KEVIN J. O'NEILL, D.D.S., M.S.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:916-786-3303
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA259631223E0200X
CA395531223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty