Provider Demographics
NPI:1134274376
Name:CONKRIGHT, JOHN E (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:CONKRIGHT
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 1:823 BELKNAP ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880
Mailing Address - Country:US
Mailing Address - Phone:715-392-4545
Mailing Address - Fax:715-392-4547
Practice Address - Street 1:823 BELKNAP ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880
Practice Address - Country:US
Practice Address - Phone:715-392-4545
Practice Address - Fax:715-392-4547
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice