Provider Demographics
NPI:1659817450
Name:ONEILL, KIMBERLY MARIE
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:ONEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 RIVEREDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01862-3029
Mailing Address - Country:US
Mailing Address - Phone:781-462-8222
Mailing Address - Fax:
Practice Address - Street 1:52 RIVEREDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01862-3029
Practice Address - Country:US
Practice Address - Phone:781-462-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADA00557126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant