Provider Demographics
NPI:1639208028
Name:MCCONATHY, DARLENE (DDS)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:MCCONATHY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19706 FM 521 RD
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-8122
Mailing Address - Country:US
Mailing Address - Phone:979-848-7723
Mailing Address - Fax:979-849-0555
Practice Address - Street 1:19706 FM 521 RD
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-8122
Practice Address - Country:US
Practice Address - Phone:979-848-7723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15186122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091168701Medicaid