Provider Demographics
NPI:1922285493
Name:CONNOR FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CONNOR FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-201-9917
Mailing Address - Street 1:840 E REDD RD
Mailing Address - Street 2:BLDG 1-B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7264
Mailing Address - Country:US
Mailing Address - Phone:915-581-1771
Mailing Address - Fax:915-581-5772
Practice Address - Street 1:840 E REDD RD
Practice Address - Street 2:BLDG 1-B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7264
Practice Address - Country:US
Practice Address - Phone:915-581-1771
Practice Address - Fax:915-581-5772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205011223G0001X
TX211131223G0001X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty