Provider Demographics
NPI:1528055365
Name:CONNORS, TERESA HELEN (DDS)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:HELEN
Last Name:CONNORS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 11TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2546
Mailing Address - Country:US
Mailing Address - Phone:360-636-2100
Mailing Address - Fax:360-636-2103
Practice Address - Street 1:911 11TH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2547
Practice Address - Country:US
Practice Address - Phone:360-636-2100
Practice Address - Fax:360-636-2103
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6464122300000X
WADE00009712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5045042OtherMEDICAL ASSISTANCE ADMIN
8852671Medicare ID - Type UnspecifiedOPTED OUT