Basic Information
| Provider Information | |||||||||
| NPI: | 1912236092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONNELL | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 7012 NE 40TH STREET | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986613052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602545254 | ||||||||
| FaxNumber: | 3609443835 | ||||||||
| Practice Location | |||||||||
| Address1: | 7012 NE 40TH STREET | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986613052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602545254 | ||||||||
| FaxNumber: | 3609443835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2009 | ||||||||
| LastUpdateDate: | 12/18/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DE60098982 | WA | Y | Dental Providers | Dentist |
No ID Information.