Provider Demographics
NPI:1467009803
Name:MCGRAW, CONOR
Entity Type:Individual
Prefix:
First Name:CONOR
Middle Name:
Last Name:MCGRAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4948
Mailing Address - Country:US
Mailing Address - Phone:812-945-5100
Mailing Address - Fax:
Practice Address - Street 1:2241 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4948
Practice Address - Country:US
Practice Address - Phone:812-945-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014030A122300000X
TN11138122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist