Provider Demographics
NPI:1629098595
Name:CONNAUGHTY, JOHN MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARTIN
Last Name:CONNAUGHTY
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 1:1101 N. 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403
Mailing Address - Country:US
Mailing Address - Phone:715-842-3081
Mailing Address - Fax:715-845-1057
Practice Address - Street 1:1101 6TH ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-3505
Practice Address - Country:US
Practice Address - Phone:715-842-3081
Practice Address - Fax:715-845-1057
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50012581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice