Provider Demographics
NPI:1649430901
Name:CONNELL, PATRICK JOESEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOESEPH
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:S27W33107 MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:DOUSMAN
Mailing Address - State:WI
Mailing Address - Zip Code:53118-9609
Mailing Address - Country:US
Mailing Address - Phone:262-968-9033
Mailing Address - Fax:
Practice Address - Street 1:S79 W 18900 JANESVILLE ROAD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-9502
Practice Address - Country:US
Practice Address - Phone:262-679-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3183-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice