Individual
BRADLEY A. MCCONNELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6029 HARRIS PKWY, FORT WORTH, TX 76132-4103
(817) 423-2223
(817) 423-2238
Mailing address
6029 HARRIS PKWY, FORT WORTH, TX 76132-4103
(817) 423-2223
(817) 423-2238
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12595
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
591273
UNITED CONCORDIA
—
01
—
D12595
BLUE CROSS & BLUE SHIELD
—
Enumeration date
06/17/2005
Last updated
07/08/2007
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