Provider Demographics
NPI:1841315090
Name:JOHN P. MARCONNIT D.D.S., P.C.
Entity type:Organization
Organization Name:JOHN P. MARCONNIT D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARCONNIT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-786-2104
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:MI
Mailing Address - Zip Code:49756-0170
Mailing Address - Country:US
Mailing Address - Phone:989-786-2104
Mailing Address - Fax:989-786-4163
Practice Address - Street 1:3051 BAY STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:MI
Practice Address - Zip Code:49756-0170
Practice Address - Country:US
Practice Address - Phone:989-786-2104
Practice Address - Fax:989-786-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13005292200000X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered292200000XLaboratoriesDental Laboratory
Not Answered332900000XSuppliersNon-Pharmacy Dispensing Site