Provider Demographics
NPI:1841414174
Name:CONNER, SHERRILL MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHERRILL
Middle Name:MARTIN
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 1:322 155TH STREET SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2590
Mailing Address - Country:US
Mailing Address - Phone:206-243-7811
Mailing Address - Fax:206-243-0259
Practice Address - Street 1:322 155TH STREET SW
Practice Address - Street 2:SUITE A
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2590
Practice Address - Country:US
Practice Address - Phone:206-243-7811
Practice Address - Fax:206-243-0259
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000074271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice