=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760937346
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DUSTIN CONNOR DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2016
-----------------------------------------------------
Last Update Date | 03/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BLDG 8647 DENTAL STREET
-----------------------------------------------------
City | BAUMHOLDER
-----------------------------------------------------
State | RHEINLAND PFALZ
-----------------------------------------------------
Zip | 55774
-----------------------------------------------------
Country | DE
-----------------------------------------------------
Telephone | 314-590-1009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | UNIT 23810 BOX 62
-----------------------------------------------------
City | APO
-----------------------------------------------------
State | AE
-----------------------------------------------------
Zip | 09034-3810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-590-1009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 30.24893
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------