Clayton Conroy, DDS
Individual provider Active NPI Dentist · Watertown, SD
NPI 1922459833 · NPPES record last updated Jun 22, 2016
Key facts
- NPI
- 1922459833
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D1112 (SD)
- 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
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: 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
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D1112 | SD | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D1112 | SD | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D1112 | Other | SD | STATE OF SD DENTAL LICENSE D1112 |
Other providers in Watertown, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2016. 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).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.