Provider Demographics
NPI:1154668333
Name:KEVIN O'CONNELL DDS LLC
Entity Type:Organization
Organization Name:KEVIN O'CONNELL DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-669-5756
Mailing Address - Street 1:149 E MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-2103
Mailing Address - Country:US
Mailing Address - Phone:860-669-5756
Mailing Address - Fax:860-664-3937
Practice Address - Street 1:149 E MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2103
Practice Address - Country:US
Practice Address - Phone:860-669-5756
Practice Address - Fax:860-664-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty