Provider Demographics
NPI:1184638769
Name:O'CONNELL, JOHN F (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 N YORK RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2991
Mailing Address - Country:US
Mailing Address - Phone:630-455-1666
Mailing Address - Fax:630-455-1667
Practice Address - Street 1:930 N YORK RD
Practice Address - Street 2:SUITE 120
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2991
Practice Address - Country:US
Practice Address - Phone:630-455-1666
Practice Address - Fax:630-455-1667
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice