Individual provider Active NPI

Maria L Connoyer, DMD

  • Public Health Dentistry
  • Quincy, IL
National Provider Identifier
1063428142
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health DentistryTaxonomy code 1223D0001X
Practice address
1415 Vermont St
Quincy, IL 62301-3119
Phone
(217) 223-5611
Fax
(217) 223-5650
NPI assigned
Jul 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health Dentistry 1223D0001X IL Primary

Addresses

Primary practice location

1415 Vermont St
Quincy, IL 62301-3119

Mailing address

1415 Vermont St
PO Box 3575
Quincy, IL 62301-3119
Phone (217) 223-5611

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150609001485 IL Order and Referring Only - DentistPractitioner - Dentist 7113248675

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019-026584ILMDPublic Health Dentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063428142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 VERMONT ST",
            "address_2": "PO BOX 3575",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623013119",
            "telephone_number": "217-223-5611",
            "fax_number": "217-223-5650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 VERMONT ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623013119",
            "telephone_number": "217-223-5611",
            "fax_number": "217-223-5650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOYER",
        "first_name": "MARIA",
        "middle_name": "L",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, IL

Sources for this page

Verify at the official NPI Registry.