Active NPI
Clayton Conroy, DDS
- Dentist
- Watertown, SD
National Provider Identifier
1922459833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D1112
- Practice address
- 600 4TH St NE
Suite 207
Watertown, SD 57201-1898 - Phone
- (605) 882-0747
- Fax
- (605) 882-2196
- NPI assigned
- Jun 22, 2016
- Last updated
- Jun 22, 2016
- Sex
- Male
- Sole proprietor
- No
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 | D1112 | SD | Primary |
Addresses
Primary practice location
600 4TH St NE
Suite 207
Watertown, SD 57201-1898
Mailing address
600 4TH St NE
Suite 207
Watertown, SD 57201-1898
Phone (605) 882-0747
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 5, 2017 through Jul 5, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D1112 | SD | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466553600000",
"number": "1922459833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 4TH ST NE",
"address_2": "SUITE 207",
"city": "WATERTOWN",
"state": "SD",
"postal_code": "572011898",
"telephone_number": "605-882-0747",
"fax_number": "605-882-2196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 4TH ST NE",
"address_2": "SUITE 207",
"city": "WATERTOWN",
"state": "SD",
"postal_code": "572011898",
"telephone_number": "605-882-0747",
"fax_number": "605-882-2196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONROY",
"first_name": "CLAYTON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-22",
"last_updated": "2016-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SD",
"license": "D1112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watertown, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2016; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.