John Martin Connaughty, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5001258 Issued in WI

Practice address

1101 6TH St
Wausau, WI 54403-3505

Phone

(715) 842-3081

Fax

(715) 845-1057

NPI assigned

Jul 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629098595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 N. 6TH ST",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "54403",
            "telephone_number": "715-842-3081",
            "fax_number": "715-845-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 6TH ST",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544033505",
            "telephone_number": "715-842-3081",
            "fax_number": "715-845-1057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNAUGHTY",
        "first_name": "JOHN",
        "middle_name": "MARTIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5001258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Wausau, WI
• Providers in Wausau, WI by specialty
• General Practice Dentistry in Wisconsin

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.