Healthcare Provider Details

I. General information

NPI: 1053230698
Provider Name (Legal Business Name): BENJAMIN MICHAEL CONNOR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EASTGATE DR
WASHINGTON IL
61571-9237
US

IV. Provider business mailing address

101 EASTGATE DR
WASHINGTON IL
61571-9237
US

V. Phone/Fax

Practice location:
  • Phone: 309-481-6150
  • Fax:
Mailing address:
  • Phone: 309-481-6150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037283
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: