Provider Demographics
NPI:1225323637
Name:CONNELL, JENNIFER MEEK (DMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MEEK
Last Name:CONNELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-9436
Mailing Address - Country:US
Mailing Address - Phone:859-824-5454
Mailing Address - Fax:859-824-9182
Practice Address - Street 1:118 S MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:DRY RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41035-9436
Practice Address - Country:US
Practice Address - Phone:859-824-5454
Practice Address - Fax:859-824-9182
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9026122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist