Healthcare Provider Details

I. General information

NPI: 1427086867
Provider Name (Legal Business Name): KESA J. MCCONNELL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 NW 63RD, STE 107
OKC OK
73116
US

IV. Provider business mailing address

3727 NW 63RD, STE 107
OKC OK
73116
US

V. Phone/Fax

Practice location:
  • Phone: 405-810-8995
  • Fax: 405-810-8984
Mailing address:
  • Phone: 405-810-8995
  • Fax: 405-810-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5877
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: