Connor Mahoney

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

S186 Issued in MN

Practice address

9281 Cedar St
Monticello, MN 55362-4507

Phone

(612) 361-5436

NPI assigned

Apr 17, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Monticello Dentistry PLLC

  • General Practice Dentistry
  • Monticello, MN
  • NPI 1255899928
  NPD (past)

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

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1891229761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 JANDELL CIRCLE NE",
            "city": "SAINT MICHAEL",
            "state": "MN",
            "postal_code": "55376",
            "telephone_number": "605-381-3963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9281 CEDAR ST",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553624507",
            "telephone_number": "612-361-5436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHONEY",
        "first_name": "CONNOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-17",
        "last_updated": "2022-08-10",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "S186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.aspendental.com/dentist/mn/monticello/9281-cedar-street",
            "affiliation": "Y",
            "affiliationName": "Polycarp Dental PLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9281 Cedar St",
            "city": "Monticello",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553624507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dennis Dean Lundquist, PT
• Luxottica Retail North America Inc
• Thomas Lyscio, D.P.T.
• Sara Macek
• Alan L Mackereth, RPH
• Deborah L Mahoney, MD
• Joseph Mahoney, MD
• Maple Lke Recovery Center Inc
• Mark C. Engasser MD PA
• Ellie Marty

• Oral and Maxillofacial Surgery (Dentist) in Monticello, MN
• Providers in Monticello, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; 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.