Provider Demographics
NPI:1205958931
Name:CONRY, JOHN PATRICK (BDS MS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:CONRY
Suffix:
Gender:M
Credentials:BDS MS
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Other - First Name:
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Mailing Address - Street 1:4419 AIR BASE ROAD
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811
Mailing Address - Country:US
Mailing Address - Phone:218-728-2117
Mailing Address - Fax:218-728-2700
Practice Address - Street 1:4419 AIR BASE ROAD
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-728-2117
Practice Address - Fax:218-728-2700
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MND108371223P0221X
MN108341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN447014100OtherMN CARE