=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285744847
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN R CONTE DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 07/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 162 A GRANVILLE ST
-----------------------------------------------------
City | GAHANNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-471-4523
-----------------------------------------------------
Fax | 614-471-3587
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 162 A GRANVILLE ST
-----------------------------------------------------
City | GAHANNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-471-4523
-----------------------------------------------------
Fax | 614-471-3587
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | OH 17478
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------