Provider Demographics
NPI:1871340976
Name:MEENAN, CONNIE MARIE (DDS)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:MARIE
Last Name:MEENAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3266 BRONZE RD NW
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-9330
Mailing Address - Country:US
Mailing Address - Phone:330-415-0388
Mailing Address - Fax:
Practice Address - Street 1:6357 N HAMILTON RD UNIT C
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-1590
Practice Address - Country:US
Practice Address - Phone:614-568-3909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist