Active NPI
Anton Conklin, D.M.D.
- General Practice Dentistry
- Medford, OR
National Provider Identifier
1194090175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 31423
- Practice address
- 1113 Progress Dr
Medford, OR 97504-5201 - Phone
- (541) 512-3900
- Fax
- (541) 512-1026
- NPI assigned
- Mar 9, 2012
- Last updated
- May 11, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D9787 | OR | |
| General Practice Dentistry | 1223G0001X | 31423 | TX | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | NU |
Addresses
Primary practice location
1113 Progress Dr
Medford, OR 97504-5201
Mailing address
5201 Walzem Rd
Windcrest, TX 78218-2122
Phone (210) 503-0000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D9787 | OR | MD | Dentist |
| 31423 | TX | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| La Clinica del Valle Family Health Care Center Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba East Medford Dental Clinic-La Clinica
- Federally Qualified Health Center (FQHC)
- Medford, OR
- NPI 1891061784
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494460800000",
"number": "1194090175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5201 WALZEM RD",
"city": "WINDCREST",
"state": "TX",
"postal_code": "782182122",
"telephone_number": "210-503-0000",
"fax_number": "281-533-6130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1113 PROGRESS DR",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975045201",
"telephone_number": "541-512-3900",
"fax_number": "541-512-1026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONKLIN",
"first_name": "ANTON",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-03-09",
"last_updated": "2017-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D9787",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "31423",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.