Provider Demographics
NPI:1134860521
Name:LEMIEUX, CONNOR THEODORE (DMD)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:THEODORE
Last Name:LEMIEUX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 LEGACY CT APT 81
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-5107
Mailing Address - Country:US
Mailing Address - Phone:978-516-8095
Mailing Address - Fax:
Practice Address - Street 1:1400 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-7574
Practice Address - Country:US
Practice Address - Phone:525-230-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist