Kent D. McConnell, D.M.D.
Individual provider Active NPI General Practice Dentistry · New Athens, IL
NPI 1154579878 · NPPES record last updated Sep 5, 2008
Key facts
- NPI
- 1154579878
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019-023730 (IL)
- Practice address
- 1002 Spotsylvania St
New Athens, IL 62264-1597 - Phone
- (618) 475-9989
- NPI assigned
- Sep 5, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-023730 | IL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019-023730 | IL | Yes |
Addresses
Primary practice location
1002 Spotsylvania St
New Athens, IL 62264-1597
Mailing address
1002 Spotsylvania St
New Athens, IL 62264-1597
Phone (618) 475-9989
Other providers in New Athens, IL
- Groceries of Southern Illinois LLC
- Robin Marion Gunter
- Joseph J Harper
- Lindsey Lehr
- Lynn Eichelberger Fiedler
- New Athens Cu School Dist 60
- New Athens Home for the Aged Inc
- Steven Mark Newbold
- Derek A Niehaus
- PC Associates, LLC
All providers in New Athens, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.