Individual
KEVAN O'NEILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MDS
Contact information
Practice address
2 DUDLEY ST, MOC 180, PROVIDENCE, RI 02905-3236
(401) 444-2299
(401) 444-2924
Mailing address
2 DUDLEY STREET, MOC 180, PROVIDENCE, RI 02905
(401) 444-2299
(401) 444-2924
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30.024958
OH
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
056003
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DEN03205
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0462064
—
OH
Enumeration date
06/07/2012
Last updated
10/16/2023
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