Provider Demographics
NPI:1164452538
Name:CONNORS, CHARLES J (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:CONNORS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GLASSWORKS RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:15338-9507
Mailing Address - Country:US
Mailing Address - Phone:724-943-3308
Mailing Address - Fax:724-943-4929
Practice Address - Street 1:1227 SMITH TOWNSHIP STATE RD
Practice Address - Street 2:
Practice Address - City:BURGETTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15021-2828
Practice Address - Country:US
Practice Address - Phone:724-947-2251
Practice Address - Fax:724-947-2477
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025571L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABC9131551OtherDEA NUMBER