Healthcare Provider Details

I. General information

NPI: 1699736652
Provider Name (Legal Business Name): MICHAEL S O'CONNELL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10715 N FRANK LLOYD WRIGHT BLVD STE 102
SCOTTSDALE AZ
85259-2691
US

IV. Provider business mailing address

10715 N FRANK LLOYD WRIGHT BLVD STE 102
SCOTTSDALE AZ
85259-2691
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-6000
  • Fax:
Mailing address:
  • Phone: 480-860-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4257
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: