Healthcare Provider Details

I. General information

NPI: 1396753661
Provider Name (Legal Business Name): KAREN LEWIS CONNELL D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 LEIGHTON AVE
ANNISTON AL
36207-3830
US

IV. Provider business mailing address

1613 LEIGHTON AVE
ANNISTON AL
36207-3830
US

V. Phone/Fax

Practice location:
  • Phone: 256-236-6021
  • Fax: 256-236-6263
Mailing address:
  • Phone: 256-236-6021
  • Fax: 256-236-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5043
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: