Provider Demographics
NPI:1386741494
Name:PHILIP D. O'NIEL III, D.D.S., P.C.
Entity type:Organization
Organization Name:PHILIP D. O'NIEL III, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:O'NIEL
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-649-2868
Mailing Address - Street 1:1579 W BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3504
Mailing Address - Country:US
Mailing Address - Phone:248-649-2869
Mailing Address - Fax:
Practice Address - Street 1:1579 W BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3504
Practice Address - Country:US
Practice Address - Phone:248-649-2869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011105261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental