Provider Demographics
NPI:1063428142
Name:CONNOYER, MARIA L (DMD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:CONNOYER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 VERMONT ST
Mailing Address - Street 2:PO BOX 3575
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3119
Mailing Address - Country:US
Mailing Address - Phone:217-223-5611
Mailing Address - Fax:217-223-5650
Practice Address - Street 1:1415 VERMONT ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3119
Practice Address - Country:US
Practice Address - Phone:217-223-5611
Practice Address - Fax:217-223-5650
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health