Provider Demographics
NPI:1174521348
Name:ONEILL, LARRY J (DMD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:ONEILL
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:PO BOX 2466
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-2466
Mailing Address - Country:US
Mailing Address - Phone:303-646-3935
Mailing Address - Fax:303-379-5380
Practice Address - Street 1:779 CROSSROADS CR
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107-7466
Practice Address - Country:US
Practice Address - Phone:303-646-3935
Practice Address - Fax:303-379-5380
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO75441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1170084826OtherNPPES