Healthcare Provider Details

I. General information

NPI: 1528997111
Provider Name (Legal Business Name): CONNOR FOLLOWELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 COLLEGE AVE
ALTON IL
62002-4700
US

IV. Provider business mailing address

3304 WATER TOWER RD
MARION IL
62959-5536
US

V. Phone/Fax

Practice location:
  • Phone: 618-889-4763
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: