Provider Demographics
NPI:1285845388
Name:MCCONNIE, MARIA M (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:M
Last Name:MCCONNIE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:M
Other - Last Name:MCCONNIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 363033
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3033
Mailing Address - Country:US
Mailing Address - Phone:787-782-5125
Mailing Address - Fax:787-782-5125
Practice Address - Street 1:ROAD 21 T-3 #6 LAS LOMAS
Practice Address - Street 2:FRENTE HOSPITAL METROPOLITANO ALTOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-782-5125
Practice Address - Fax:787-782-5125
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice