Provider Demographics
NPI:1366654188
Name:THOMAS R CONNER DDS PA
Entity Type:Organization
Organization Name:THOMAS R CONNER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-771-3684
Mailing Address - Street 1:109 E KAUFMAN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2529
Mailing Address - Country:US
Mailing Address - Phone:972-771-3684
Mailing Address - Fax:972-771-3777
Practice Address - Street 1:109 E KAUFMAN ST
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2529
Practice Address - Country:US
Practice Address - Phone:972-771-3684
Practice Address - Fax:972-771-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10032261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental