Active NPI
James Merrill Conly, D.D.S.
- Dentist
- Coushatta, LA
National Provider Identifier
1801917265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2350
- Practice address
- 1912 E Carrol St
Coushatta, LA 71019-8560 - Phone
- (318) 932-9820
- Fax
- (318) 932-4845
- NPI assigned
- Apr 3, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2350 | LA | Primary |
Addresses
Primary practice location
1912 E Carrol St
Coushatta, LA 71019-8560
Mailing address
P.O. Box 503
Coushatta, LA 71019
Phone (318) 932-9820
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1823503 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2350 | LA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801917265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 503",
"city": "COUSHATTA",
"state": "LA",
"postal_code": "71019",
"telephone_number": "318-932-9820",
"fax_number": "318-932-4845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1912 E CARROL ST",
"city": "COUSHATTA",
"state": "LA",
"postal_code": "710198560",
"telephone_number": "318-932-9820",
"fax_number": "318-932-4845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONLY",
"first_name": "JAMES",
"middle_name": "MERRILL",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "LA",
"license": "2350",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1823503",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coushatta, LA
Sources for this page
- 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.