Provider Demographics
NPI:1407041536
Name:OCONNELL, NINA D (DMD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:D
Last Name:OCONNELL
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 1:528 DUDLEY CT
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3029
Mailing Address - Country:US
Mailing Address - Phone:908-317-2854
Mailing Address - Fax:
Practice Address - Street 1:169 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3141
Practice Address - Country:US
Practice Address - Phone:908-654-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI020988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist