Provider Demographics
NPI:1083785091
Name:CONNER, GREGORY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:CONNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 HYDRAULIC RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901
Mailing Address - Country:US
Mailing Address - Phone:434-973-3348
Mailing Address - Fax:434-977-5790
Practice Address - Street 1:244 HYDRAULIC RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901
Practice Address - Country:US
Practice Address - Phone:434-973-3348
Practice Address - Fax:434-977-5790
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery