Provider Demographics
NPI:1619232881
Name:CONNOR, AMY OTTERPOHL (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:OTTERPOHL
Last Name:CONNOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MAPLE ROW BLVD STE D402
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3777
Mailing Address - Country:US
Mailing Address - Phone:615-824-9774
Mailing Address - Fax:615-826-1693
Practice Address - Street 1:131 MAPLE ROW BLVD STE D402
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3777
Practice Address - Country:US
Practice Address - Phone:615-824-9774
Practice Address - Fax:615-826-1693
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS9497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist