NPIMap

Organization Active NPI

L. Michelle Conner DDS PA Dba Beacon Dental Center

Doing business as Beacon Dental Center

  • Dental Clinic/Center
  • Charlotte, NC
National Provider Identifier
1932411311
Registry record updated Jul 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
6133 Issued in ND
Legal business name
L. MICHELLE CONNER DDS PA DBA BEACON DENTAL CENTER
Doing business as
Beacon Dental Center
Practice address
4805 Park Rd
#223
Charlotte, NC 28209-3803
Phone
(704) 527-1228
NPI assigned
Jul 13, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2010

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

Authorized official

Name
Dr. Lillian Michelle Conner, DDSNPI 1437111523
Title
Owner
Phone
(704) 527-1228

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 6133 ND Primary

Addresses

Primary practice location

4805 Park Rd
#223
Charlotte, NC 28209-3803

Mailing address

4805 Park Rd
#223
Charlotte, NC 28209-3803
Phone (704) 527-1228

Other identifiers 1

IdentifierTypeStateIssuer
89902A2MedicaidNC

Other names 1

  • Beacon Dental Center Doing business as

National Provider Directory

National Provider Directory

Locations

4805 Park Rd
Ste 223
Charlotte, NC 28209
Phone (704) 527-1228

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1278979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278979200000",
    "number": "1932411311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4805 PARK RD",
            "address_2": "#223",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093803",
            "telephone_number": "704-527-1228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 PARK RD",
            "address_2": "#223",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093803",
            "telephone_number": "704-527-1228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "L. MICHELLE CONNER DDS PA DBA BEACON DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-13",
        "last_updated": "2010-07-13",
        "status": "A",
        "authorized_official_last_name": "CONNER",
        "authorized_official_first_name": "LILLIAN",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-527-1228",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ND",
            "license": "6133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89902A2",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; 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.