Active NPI
John L Connolly, DDS
- General Practice Dentistry
- Cloquet, MN
National Provider Identifier
1396813820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8214
- Practice address
- 1600 Washington Ave
Cloquet, MN 55720 - Phone
- (218) 879-6703
- Fax
- (218) 499-8033
- NPI assigned
- Dec 1, 2006
- Last updated
- Feb 9, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8214 | MN | Primary |
Addresses
Primary practice location
1600 Washington Ave
Cloquet, MN 55720
Mailing address
1600 Washington Ave
Cloquet, MN 55720
Phone (218) 879-6703
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160318002033 | MN | Order and Referring Only - Oral Surgery | 9931406915 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8214 | MN | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707436800000",
"number": "1396813820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 WASHINGTON AVE",
"city": "CLOQUET",
"state": "MN",
"postal_code": "55720",
"telephone_number": "218-879-6703",
"fax_number": "218-879-7029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 WASHINGTON AVE",
"city": "CLOQUET",
"state": "MN",
"postal_code": "55720",
"telephone_number": "218-879-6703",
"fax_number": "218-499-8033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "JOHN",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-01",
"last_updated": "2024-02-09",
"certification_date": "2024-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "8214",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cloquet, MN
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- Compassionate Quality Psychiatry PLLC
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- Lindsey Ann Cook
- Konner Cooke
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- County of Carlton (Carlton County Public Health & Human Services)
- County of Carlton (Carlton County Public Health)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; 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.