Healthcare Provider Details

I. General information

NPI: 1902667587
Provider Name (Legal Business Name): MELISSA CONNELL, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOTT ST
BLUFFTON SC
29910-5215
US

IV. Provider business mailing address

5 MOTT ST
BLUFFTON SC
29910-5215
US

V. Phone/Fax

Practice location:
  • Phone: 843-227-3177
  • Fax: 843-535-5925
Mailing address:
  • Phone: 843-227-3177
  • Fax: 843-535-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA CONNELL
Title or Position: OWNER
Credential: DDS
Phone: 312-848-2282