MEDICARE: SONYA CONNER R.D.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	8619	TX

General Provider Information

NPI Number	:	1396925798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONYA CONNER R.D.H.

Provider Business Mailing Address
First Line	:	601 S MAIN ST
Second Line	:	SUITE 220
City	:	KELLER
State	:	TX
Zip	:	76248-7029
Country	:	US
Telephone Number	:	817-741-8390
Fax Number	:	817-741-8394

Provider Business Practice Location Address
First Line	:	601 S MAIN ST
Second Line	:	SUITE 220
City	:	KELLER
State	:	TX
Zip	:	76248-7029
Country	:	US
Telephone Number	:	817-741-8390
Fax Number	:	817-741-8394

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	11/14/2007

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