Provider Demographics
NPI:1154835775
Name:ROBERT B. CONNOR DMD, PC
Entity Type:Organization
Organization Name:ROBERT B. CONNOR DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BLACKSHER
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-870-9871
Mailing Address - Street 1:1771 INDEPENDENCE CT.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216
Mailing Address - Country:US
Mailing Address - Phone:205-870-9871
Mailing Address - Fax:205-870-9875
Practice Address - Street 1:1771 INDEPENDENCE CT.
Practice Address - Street 2:SUITE 1
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216
Practice Address - Country:US
Practice Address - Phone:205-870-9871
Practice Address - Fax:205-870-9875
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT B. CONNOR DMD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2986122300000X
AL6405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty