Courtney Bullard Conn, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11855 Issued in NC

Practice address

315 Hwy 55
Mount Olive, NC 28365

Phone

(919) 658-9555

NPI assigned

Aug 28, 2020

Last updated

Aug 28, 2020By the provider in NPPES

Sex

Female

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 NC

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1639782709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 NANTUCKET RD # B",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278342168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 HWY 55",
            "city": "MOUNT OLIVE",
            "state": "NC",
            "postal_code": "28365",
            "telephone_number": "919-658-9555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONN",
        "first_name": "COURTNEY",
        "middle_name": "BULLARD",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-28",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "11855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Renee Cashwell, COTA/L
• Sharonda Chancy
• Chatabout Speech Therapy
• Serena Cole
• Whitney Combs, PTA
• Dolores M Corbin, LPA
• Crescent Foods, Inc. (Mt Olive Pharmacy)
• Crescent Foods, Inc. (Mt. Olive Pharmacy)
• Kevin Cross, PHARM.D.
• Wantee Cross

• General Practice Dentistry in Mount Olive, NC
• Providers in Mount Olive, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; 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.