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General NPI Number Information
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NPI Number | 1770135923
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Entity Type | Organization
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Legal Business Name | MCCONNELL DENTAL CARE III
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Dates
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Enumeration Date | 07/09/2019
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 263 COUNTRY CLB STE 102
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City | STANSBURY PARK
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State | UT
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Zip | 84074-9602
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Country | US
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Telephone | 435-830-4967
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Fax |
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Provider Business Mailing Address
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Address Line | 263 COUNTRY CLB STE 102
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City | STANSBURY PARK
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State | UT
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Zip | 84074-9602
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Country | US
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Telephone | 435-830-4967
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES FARRELL MCCONNELL III
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Credential | DMD
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Telephone | 435-830-4967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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