Provider Demographics
NPI:1730413261
Name:O'CONNELL, MEGHAN KATHLEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:KATHLEEN
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MEGHAN
Other - Middle Name:KATHLEEN
Other - Last Name:FAHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2748 WORTH RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6031
Mailing Address - Country:US
Mailing Address - Phone:210-221-6326
Mailing Address - Fax:210-221-7161
Practice Address - Street 1:2748 WORTH RD
Practice Address - Street 2:SUITE 4
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6031
Practice Address - Country:US
Practice Address - Phone:210-221-6326
Practice Address - Fax:210-221-7161
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6446-015122300000X, 1223G0001X, 1223X0400X
TX316861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice