Active NPI
Deanna Lynn O'Neil, DDS
- Pediatric Dentistry
- South Bend, IN
National Provider Identifier
1508972837
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 12011222A
- Practice address
- 103 S Eddy St
South Bend, IN 46617-3101 - Phone
- (574) 288-4400
- Fax
- (574) 288-5437
- NPI assigned
- Aug 21, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 5026015 | WI | |
| Pediatric Dentistry | 1223P0221X | 12011222A | IN | Primary |
Addresses
Primary practice location
103 S Eddy St
South Bend, IN 46617-3101
Mailing address
103 S Eddy St
South Bend, IN 46617-3101
Phone (574) 288-4400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12011222A | IN | MD | Pediatric Dentist |
| 5026015 | WI | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Bend Childrens Dentistry PC | Pediatric Dentistry | Past | Accepting new patients |
Interoperability endpoints
- doneil1158660@direct.trinity-health.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- South Bend, IN
- NPI 1366579005
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359417600000",
"number": "1508972837",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 S EDDY ST",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466173101",
"telephone_number": "574-288-4400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 S EDDY ST",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466173101",
"telephone_number": "574-288-4400",
"fax_number": "574-288-5437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'NEIL",
"first_name": "DEANNA",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-21",
"last_updated": "2013-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "WI",
"license": "5026015",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "IN",
"license": "12011222A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.