Healthcare Provider Details

I. General information

NPI: 1366433633
Provider Name (Legal Business Name): JOHN N CONNIFF DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 MISSOURI AVE SUITE C
LAS CRUCES NM
88011-5091
US

IV. Provider business mailing address

1500 SNOW RD
LAS CRUCES NM
88005-3941
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-8229
  • Fax: 505-522-8123
Mailing address:
  • Phone: 505-525-1411
  • Fax: 505-522-8123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDD1027
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: