Provider Demographics
NPI:1952385999
Name:EMBRY & O CONNOR INC
Entity Type:Organization
Organization Name:EMBRY & O CONNOR INC
Other - Org Name:JAMES L O CONNOR DMD
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:O CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-268-5903
Mailing Address - Street 1:25 AGIN WAY
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:KY
Mailing Address - Zip Code:40045-1509
Mailing Address - Country:US
Mailing Address - Phone:502-268-3192
Mailing Address - Fax:
Practice Address - Street 1:25 AGIN WAY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:KY
Practice Address - Zip Code:40045-1509
Practice Address - Country:US
Practice Address - Phone:502-268-3192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61941373Medicaid
KY60054038Medicaid