Provider Demographics
NPI:1447351150
Name:O'NEILL, KEVIN KEITH (DDS, PC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KEITH
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6990 S HOLLY CIR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1018
Mailing Address - Country:US
Mailing Address - Phone:303-224-9400
Mailing Address - Fax:
Practice Address - Street 1:6990 S HOLLY CIR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1018
Practice Address - Country:US
Practice Address - Phone:303-224-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1056731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice