Provider Demographics
NPI:1376930966
Name:STEVEN MCCONNELL, DDS INC
Entity Type:Organization
Organization Name:STEVEN MCCONNELL, DDS INC
Other - Org Name:THE MARIN CENTER FOR RESTORATIVE & COSMETIC DENTSITRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-897-4149
Mailing Address - Street 1:1730 NOVATO BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3048
Mailing Address - Country:US
Mailing Address - Phone:415-897-4149
Mailing Address - Fax:415-892-2309
Practice Address - Street 1:1730 NOVATO BLVD STE A
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3048
Practice Address - Country:US
Practice Address - Phone:415-897-4149
Practice Address - Fax:415-892-2309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty