Provider Demographics
NPI:1538368733
Name:OCONNELL, DANIEL E (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:OCONNELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 EAST FIFTH ROAD
Mailing Address - Street 2:
Mailing Address - City:LASALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301
Mailing Address - Country:US
Mailing Address - Phone:815-223-2943
Mailing Address - Fax:
Practice Address - Street 1:206 MARQUETTE ST
Practice Address - Street 2:
Practice Address - City:LASALLE
Practice Address - State:IL
Practice Address - Zip Code:61301
Practice Address - Country:US
Practice Address - Phone:815-224-3140
Practice Address - Fax:815-224-4803
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice