MEDICARE: DR. JOHN RANDOLPH CONNER JR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	1354219922	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	869074	OTHER	PA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1033212576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN RANDOLPH CONNER JR. DDS

Provider Business Mailing Address
First Line	:	1345 E 3900 S
Second Line	:	#214
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-4414
Country	:	US
Telephone Number	:	801-277-2637
Fax Number	:	801-277-2638

Provider Business Practice Location Address
First Line	:	1345 E 3900 S
Second Line	:	#214
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-4414
Country	:	US
Telephone Number	:	801-277-2637
Fax Number	:	801-277-2638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	01/11/2026

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