Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2009013175 | MO |
NPI | 1396972501 |
---|---|
Provider Name | Dr. Benjamin Jeffrey Connor |
First Address | Saint Louis, MO 63150-2852 |
Second Address | Washington, MO 63090-3135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2009 |
Last Update Date | 13/01/2014 |