Provider Demographics
NPI:1578863403
Name:CONNER, THOMAS ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANDREW
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 1:9510 IRON BRIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6400
Mailing Address - Country:US
Mailing Address - Phone:804-768-7600
Mailing Address - Fax:804-768-0115
Practice Address - Street 1:9510 IRON BRIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6400
Practice Address - Country:US
Practice Address - Phone:804-768-7600
Practice Address - Fax:804-768-0115
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist