Provider Demographics
NPI:1902364953
Name:AMES, CONNER WESLEY (DMD)
Entity Type:Individual
Prefix:
First Name:CONNER
Middle Name:WESLEY
Last Name:AMES
Suffix:
Gender:M
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:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:PORT HADLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98339-0428
Mailing Address - Country:US
Mailing Address - Phone:360-385-1000
Mailing Address - Fax:360-385-0899
Practice Address - Street 1:131 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:PORT HADLOCK
Practice Address - State:WA
Practice Address - Zip Code:98339-8507
Practice Address - Country:US
Practice Address - Phone:360-385-1000
Practice Address - Fax:360-385-0899
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60876009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist