MEDICARE: DR. MELISSA MARIE CONNELL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	019-025711	IL
2	1223P0221X	Pediatric Dentistry	DGD10949	SC

General Provider Information

NPI Number	:	1659513950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA MARIE CONNELL DDS

Provider Business Mailing Address
First Line	:	PO BOX 453
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-0453
Country	:	US
Telephone Number	:	312-848-2282
Fax Number	:	843-595-5925

Provider Business Practice Location Address
First Line	:	5 MOTT ST
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-5215
Country	:	US
Telephone Number	:	312-848-2282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	12/21/2025

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