Provider Demographics
NPI:1942416888
Name:CONNELL, CHRISTOPHER MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name: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 1:5395 MEADOW WOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3754
Mailing Address - Country:US
Mailing Address - Phone:440-449-9848
Mailing Address - Fax:
Practice Address - Street 1:5406 MAYFIELD RD
Practice Address - Street 2:LYNDHURST COMMONS
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2912
Practice Address - Country:US
Practice Address - Phone:440-684-4000
Practice Address - Fax:440-684-4024
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300192751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice