Individual
LATANYA A O'NEAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
(DDS)
Contact information
Practice address
9012 MATHIS AVE, MANASSAS, VA 20110-5218
(571) 921-1111
(571) 921-1112
Mailing address
201 W 8TH ST, SUITE 810, PUEBLO, CO 81003-3038
(719) 562-4447
(719) 583-1801
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401411960
VA
1223G0001X
General Practice Dentistry
DN012258
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
822177721A
—
GA
01
—
9180172
DORAL
GA
05
—
9180172
—
VA
Enumeration date
02/26/2006
Last updated
05/16/2011
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