MEDICARE: L. MICHELLE CONNER DDS PA DBA BEACON DENTAL CENTER

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	261QD0000X	Dental Clinic/Center	6133	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932411311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L. MICHELLE CONNER DDS PA DBA BEACON DENTAL CENTER

Provider Business Mailing Address
First Line	:	4805 PARK RD
Second Line	:	#223
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3803
Country	:	US
Telephone Number	:	704-527-1228
Fax Number	:

Provider Business Practice Location Address
First Line	:	4805 PARK RD
Second Line	:	#223
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3803
Country	:	US
Telephone Number	:	704-527-1228
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LILLIAN MICHELLE CONNER
Credential	:	DDS
Telephone Number	:	704-527-1228

Provider Enumeration Date	:	07/13/2010
Last Update Date	:	07/13/2010

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