Healthcare Provider Details

I. General information

NPI: 1982233961
Provider Name (Legal Business Name): DRAKE WESTON CONNER DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17300 N OUTER 40 RD STE 103
CHESTERFIELD MO
63005-1364
US

IV. Provider business mailing address

660 RALPH MCGILL BLVD NE APT 4304
ATLANTA GA
30312-1163
US

V. Phone/Fax

Practice location:
  • Phone: 636-223-5101
  • Fax:
Mailing address:
  • Phone: 636-575-4919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2025016748
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: