Healthcare Provider Details

I. General information

NPI: 1447728589
Provider Name (Legal Business Name): STEVEN L MCCONNELL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MILLER AVE
MILL VALLEY CA
94903
US

IV. Provider business mailing address

535 MILLER AVE
MILL VALLEY CA
94903
US

V. Phone/Fax

Practice location:
  • Phone: 405-388-2172
  • Fax: 415-388-0283
Mailing address:
  • Phone: 405-388-2172
  • Fax: 415-388-0283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: STEVEN L MCCONNELL
Title or Position: DDS
Credential:
Phone: 415-897-4149