Provider Demographics
NPI:1396972501
Name:CONNOR, BENJAMIN JEFFREY (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JEFFREY
Last Name:CONNOR
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:PO BOX 502852
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-2852
Mailing Address - Country:US
Mailing Address - Phone:636-239-8585
Mailing Address - Fax:636-239-8553
Practice Address - Street 1:851 E 5TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3135
Practice Address - Country:US
Practice Address - Phone:636-239-8585
Practice Address - Fax:636-239-8553
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090131751223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health