Individual provider Active NPI

Mary Alice Connor, DMD

  • General Practice Dentistry
  • Greensburg, PA
National Provider Identifier
1477677672
Registry record updated Mar 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS024044-L Issued in PA
Practice address
3126 McClellan Dr
Greensburg, PA 15601-3823
Phone
(724) 834-5415
Fax
(724) 834-5415
NPI assigned
Mar 16, 2007
Last updated
Mar 19, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS024044-L PA Primary

Addresses

Primary practice location

3126 McClellan Dr
Greensburg, PA 15601-3823

Mailing address

3126 McClellan Dr
Greensburg, PA 15601-3823
Phone (724) 834-5415

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20150304001467 PA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 3274859582

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS024044-LPAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426723200000",
    "number": "1477677672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3126 MCCLELLAN DR",
            "city": "GREENSBURG",
            "state": "PA",
            "postal_code": "156013823",
            "telephone_number": "724-834-5415",
            "fax_number": "724-834-5415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3126 MCCLELLAN DR",
            "city": "GREENSBURG",
            "state": "PA",
            "postal_code": "156013823",
            "telephone_number": "724-834-5415",
            "fax_number": "724-834-5415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOR",
        "first_name": "MARY",
        "middle_name": "ALICE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-16",
        "last_updated": "2015-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS024044-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensburg, PA

Sources for this page

Verify at the official NPI Registry.