Organization
TIMOTHY I. MCCONNELL D.M.D. P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY IVAN MCCONNELL D.M.D (OWNER)
(843) 553-5235
Entity
Organization
Contact information
Practice address
100 BERKELEY SQUARE LN, GOOSE CREEK, SC 29445-2958
(843) 553-5235
(843) 797-8189
Mailing address
PO BOX 1120, GOOSE CREEK, SC 29445-1120
(843) 553-5235
(843) 797-8189
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1759
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
179343
UNITED CONCORDIA INS #
SC
05
—
Z17599
—
SC
Enumeration date
05/04/2006
Last updated
04/04/2011
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