Provider Demographics
NPI:1508349499
Name:MCCONNELL DENTAL CARE II
Entity Type:Organization
Organization Name:MCCONNELL DENTAL CARE II
Other - Org Name:WENDOVER DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FARRELL
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-830-4967
Mailing Address - Street 1:399 ARIA BLVD
Mailing Address - Street 2:
Mailing Address - City:WENDOVER
Mailing Address - State:UT
Mailing Address - Zip Code:84083-4550
Mailing Address - Country:US
Mailing Address - Phone:435-665-2962
Mailing Address - Fax:
Practice Address - Street 1:399 ARIA BLVD
Practice Address - Street 2:
Practice Address - City:WENDOVER
Practice Address - State:UT
Practice Address - Zip Code:84083-4550
Practice Address - Country:US
Practice Address - Phone:435-665-2962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT369873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty