Active NPI
John David Conner, D.D.S.
- Dentist
- Wabash, IN
National Provider Identifier
1891004503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12011312A
- Practice address
- 1146 N. Cass Street
Suite C
Wabash, IN 46992-1836 - Phone
- (260) 563-4805
- Fax
- (260) 563-2958
- NPI assigned
- Sep 29, 2010
- Last updated
- Apr 21, 2011
- 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 | 12011312A | IN | Primary |
Addresses
Primary practice location
1146 N. Cass Street
Suite C
Wabash, IN 46992-1836
Mailing address
1146 N. Cass Street
Suite C
Wabash, IN 46992-1836
Phone (260) 563-4805
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 |
|---|---|---|---|
| 12011312A | IN | MD | Dentist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303344000000",
"number": "1891004503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1146 N. CASS STREET",
"address_2": "SUITE C",
"city": "WABASH",
"state": "IN",
"postal_code": "469921836",
"telephone_number": "260-563-4805",
"fax_number": "260-563-2958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1146 N. CASS STREET",
"address_2": "SUITE C",
"city": "WABASH",
"state": "IN",
"postal_code": "469921836",
"telephone_number": "260-563-4805",
"fax_number": "260-563-2958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNER",
"first_name": "JOHN",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-29",
"last_updated": "2011-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12011312A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wabash, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.