Provider Demographics
NPI:1437299013
Name:MCCONNELL, RAYMOND V (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:V
Last Name:MCCONNELL
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 1:11 BANK ST
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-4801
Mailing Address - Country:US
Mailing Address - Phone:401-821-3149
Mailing Address - Fax:401-822-5077
Practice Address - Street 1:11 BANK ST
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-4801
Practice Address - Country:US
Practice Address - Phone:401-821-3149
Practice Address - Fax:401-822-5077
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI14021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI8259-2OtherBLUE CROSS
RIRM03011Medicaid