Provider Demographics
NPI:1992931000
Name:CHAUNCEY L. CONNER DDS LLC
Entity type:Organization
Organization Name:CHAUNCEY L. CONNER DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALGUERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-354-0079
Mailing Address - Street 1:1200 BARRETT PARKWAY
Mailing Address - Street 2:SUITE 13
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144
Mailing Address - Country:US
Mailing Address - Phone:678-354-0079
Mailing Address - Fax:678-354-0062
Practice Address - Street 1:1200 BARRETT PKWY
Practice Address - Street 2:SUITE 13
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7557
Practice Address - Country:US
Practice Address - Phone:678-354-0079
Practice Address - Fax:678-354-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty