Healthcare Provider Details

I. General information

NPI: 1841315090
Provider Name (Legal Business Name): JOHN P. MARCONNIT D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 BAY STREET
LEWISTON MI
49756-0170
US

IV. Provider business mailing address

PO BOX 170
LEWISTON MI
49756-0170
US

V. Phone/Fax

Practice location:
  • Phone: 989-786-2104
  • Fax: 989-786-4163
Mailing address:
  • Phone: 989-786-2104
  • Fax: 989-786-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number13005
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN P MARCONNIT
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 989-786-2104