Provider Demographics
NPI:1710012497
Name:O'CONNELL, KEVIN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:O'CONNELL
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 1:149 E MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-2103
Mailing Address - Country:US
Mailing Address - Phone:860-669-5756
Mailing Address - Fax:860-664-3937
Practice Address - Street 1:149-4 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413
Practice Address - Country:US
Practice Address - Phone:860-669-5756
Practice Address - Fax:860-664-3937
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0091861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice