Healthcare Provider Details

I. General information

NPI: 1639208028
Provider Name (Legal Business Name): DARLENE MCCONATHY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19706 FM 521 RD
ROSHARON TX
77583-8122
US

IV. Provider business mailing address

19706 FM 521 RD
ROSHARON TX
77583-8122
US

V. Phone/Fax

Practice location:
  • Phone: 979-848-7723
  • Fax:
Mailing address:
  • Phone: 979-848-7723
  • Fax: 979-849-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number15186
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15186
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: