Conner Patrick Allison

Individual provider Active NPI General Practice Dentistry · Mandeville, LA

NPI 1437846342 · NPPES record last updated May 23, 2023

Key facts

NPI
1437846342
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
7411 (LA)
Practice address
2030 N Causeway Blvd
Mandeville, LA 70471-3116
Phone
(985) 626-3338
NPI assigned
Apr 20, 2023
Sex
Male
Sole proprietor
Yes

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 and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
7411LAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Northlake Dental LLC General Practice Current
since Apr 23, 2023
Accepting new patients

Locations

2030 N Causeway Blvd
Mandeville, LA 70471
Phone (985) 626-3338

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry
Group: 193400000X SINGLE SPECIALTY GROUP
1223G0001X 7411 LA Yes

Addresses

Primary practice location

2030 N Causeway Blvd
Mandeville, LA 70471-3116

Mailing address

2030 N Causeway Blvd
Mandeville, LA 70471-3116
Phone (985) 276-0206

Other providers in Mandeville, LA

All providers in Mandeville, LA · General Practice Dentistry in Louisiana

Sources for this page

Verify at the official NPI Registry.