MEDICARE: DR. MEGHAN KATHLEEN O'CONNELL D.D.S.

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	122300000X	Dentist	6446-015	WI
2	1223G0001X	General Practice Dentistry	6446-015	WI
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6446-015	WI
4	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	31686	TX

General Provider Information

NPI Number	:	1730413261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGHAN KATHLEEN O'CONNELL D.D.S.

Provider Business Mailing Address
First Line	:	2748 WORTH RD
Second Line	:	SUITE 4
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-6031
Country	:	US
Telephone Number	:	210-221-6326
Fax Number	:	210-221-7161

Provider Business Practice Location Address
First Line	:	2748 WORTH RD
Second Line	:	SUITE 4
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-6031
Country	:	US
Telephone Number	:	210-221-6326
Fax Number	:	210-221-7161

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

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	07/09/2019

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