John Michael Conness, DDS
Individual provider Active NPI General Practice Dentistry · Ottawa, IL
NPI 1669570263 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1669570263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019018550 (IL)
- Practice address
- 1704 Polaris Cir Ste 1
Ottawa, IL 61350-1774 - Phone
- (815) 434-1022
- Fax
- (815) 434-1047
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190912002160 | IL | Order and Referring Only - Dentist |
1254660491 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019018550 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John M Conness DDS | General Practice | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019018550 | IL | Yes |
Addresses
Primary practice location
1704 Polaris Cir Ste 1
Ottawa, IL 61350-1774
Mailing address
1704 Polaris Circle
Suite 1
Ottawa, IL 61350-4735
Phone (815) 434-1022
Other providers in Ottawa, IL
- Community Hospital of Ottawa
- Community Hospital of Ottawa
- Community Hospital of Ottawa
- Community Hospital of Ottawa
- Julie Ann Connelly
- Kevin Michael Cook
- John Cooper
- Jeffrey A. Crowhurst
- Daniel J Miller DC Chiropractic Clinic SC
- Bruce B Dannenberger
All providers in Ottawa, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.