Provider Demographics
NPI:1699848812
Name:CONSAMUS, MARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:CONSAMUS
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 1:3324 ORION DR
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4378
Mailing Address - Country:US
Mailing Address - Phone:515-232-2007
Mailing Address - Fax:
Practice Address - Street 1:3324 ORION DR
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-4378
Practice Address - Country:US
Practice Address - Phone:515-232-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA67321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1186866Medicaid