Provider Demographics
NPI:1912236142
Name:O'NEILL, CASEY (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3814
Mailing Address - Street 2:
Mailing Address - City:SUNRIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97707-0814
Mailing Address - Country:US
Mailing Address - Phone:541-593-0113
Mailing Address - Fax:541-593-4483
Practice Address - Street 1:56825 VENTURE LN
Practice Address - Street 2:SUITE 107
Practice Address - City:SUNRIVER
Practice Address - State:OR
Practice Address - Zip Code:97707-2160
Practice Address - Country:US
Practice Address - Phone:541-593-0113
Practice Address - Fax:541-593-4483
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD93611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics