Provider Demographics
NPI:1649318882
Name:DR. THOMASON M MCCONNELL DDS
Entity type:Organization
Organization Name:DR. THOMASON M MCCONNELL DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMASON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-458-9100
Mailing Address - Street 1:1200 W 4TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5013
Mailing Address - Country:US
Mailing Address - Phone:918-458-9100
Mailing Address - Fax:918-458-9200
Practice Address - Street 1:1200 W 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5013
Practice Address - Country:US
Practice Address - Phone:918-458-9100
Practice Address - Fax:918-458-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
814714OtherUNITED CONCORDIA
VA214781OtherTRIGON