Provider Demographics
NPI:1265899637
Name:JOHN M CONNESS DDS
Entity type:Organization
Organization Name:JOHN M CONNESS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CONNESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-672-2080
Mailing Address - Street 1:211 ARMORY CT
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2768
Mailing Address - Country:US
Mailing Address - Phone:815-672-2080
Mailing Address - Fax:815-672-4119
Practice Address - Street 1:211 ARMORY CT
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-2768
Practice Address - Country:US
Practice Address - Phone:815-672-2080
Practice Address - Fax:815-672-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190185501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty