Mark John Connelly, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13432 Issued in MI

Practice address

911 E State St
Suite C
Saint Johns, MI 48879-1684

Phone

(989) 224-2379

NPI assigned

Jun 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Dental Services PC

  • General Practice Dentistry
  • Saint Johns, MI
  • NPI 1053525899
  NPD (past) Authorized official
• Dr Capen Dental Care, PLLC

  • Dental Clinic/Center
  • Saint Johns, MI
  • NPI 1962384412
  NPD (past)

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235168683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 E STATE ST",
            "address_2": "SUITE C",
            "city": "SAINT JOHNS",
            "state": "MI",
            "postal_code": "488791684",
            "telephone_number": "989-224-2379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 E STATE ST",
            "address_2": "SUITE C",
            "city": "SAINT JOHNS",
            "state": "MI",
            "postal_code": "488791684",
            "telephone_number": "989-224-2379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELLY",
        "first_name": "MARK",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "13432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clinton County Medical Center PC
• Clinton County Medical Center Psychological Services PLLC
• Clinton County Medical Center Psychological Services PLLC
• Clinton County Resa
• Clinton Ophthalmology, PC
• Brandy Elizabeth Cook, D.O.
• Karrah Cooley, LLPC
• Cynthia Marie Cooney
• Michael Paul-David Cooper, LMSW
• Joseph Anthony Cosentino

• General Practice Dentistry in Saint Johns, MI
• Providers in Saint Johns, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.