Provider Demographics
NPI:1942615232
Name:ELMITT, CONNOR GEORGE (DDS)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:GEORGE
Last Name:ELMITT
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 1:5495 NW 100TH ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-4808
Mailing Address - Country:US
Mailing Address - Phone:515-331-1600
Mailing Address - Fax:
Practice Address - Street 1:5495 NW 100TH ST
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-4808
Practice Address - Country:US
Practice Address - Phone:515-331-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist