Provider Demographics
NPI:1316013188
Name:MCCONNELL AND MCCONNELL DDS PA
Entity Type:Organization
Organization Name:MCCONNELL AND MCCONNELL DDS PA
Other - Org Name:MCCONNELL FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-799-9854
Mailing Address - Street 1:136 SUNRISE CIR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6675
Mailing Address - Country:US
Mailing Address - Phone:704-799-9854
Mailing Address - Fax:704-660-3354
Practice Address - Street 1:118 KENDRA DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5816
Practice Address - Country:US
Practice Address - Phone:704-660-3540
Practice Address - Fax:704-660-3354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70091223G0001X
NC68421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty