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NPI Code Detail

MEDICARE: MELISSA CONNELL, DDS

MEDICARE: MELISSA 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
11223P0221XPediatric Dentistry

General Provider Information

NPI Number : 1902667587
Entity Type Code : Organization
Provider Name (Legal Business Name) : MELISSA CONNELL, DDS
Provider Business Mailing Address
First Line : 1615 N WOLCOTT AVE STE 1
Second Line :
City : CHICAGO
State : IL
Zip : 60622-1362
Country : US
Telephone Number : 312-848-2282
Fax Number :
Provider Business Practice Location Address
First Line : 1615 N WOLCOTT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60622-1338
Country : US
Telephone Number : 312-848-2282
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. MELISSA CONNELL
Credential : DDS
Telephone Number : 312-848-2282
Provider Enumeration Date : 01/19/2024
Last Update Date : 01/19/2024

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