Provider Demographics
NPI:1700984937
Name:CONNOR, DONALD PATRICK (DMD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:PATRICK
Last Name:CONNOR
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 1:5454 S GENEVA WAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6220
Mailing Address - Country:US
Mailing Address - Phone:303-478-6579
Mailing Address - Fax:303-770-6231
Practice Address - Street 1:5454 S GENEVA WAY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-6220
Practice Address - Country:US
Practice Address - Phone:303-478-6579
Practice Address - Fax:303-770-6231
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44888775Medicaid