Provider Demographics
NPI:1902895634
Name:OCONNELL, ANN L (DDS)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 STONE RD
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1908
Mailing Address - Country:US
Mailing Address - Phone:763-689-7306
Mailing Address - Fax:
Practice Address - Street 1:1235 HIGHWAY 293 S
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-9002
Practice Address - Country:US
Practice Address - Phone:763-689-7306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN98771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice