1952385999 NPI number — EMBRY & O CONNOR INC

Table of content: (NPI 1952385999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952385999 NPI number — EMBRY & O CONNOR INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMBRY & O CONNOR INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JAMES L O CONNOR DMD
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952385999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 AGIN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40045-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-268-3192
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 AGIN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40045-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-268-3192
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
O CONNOR
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
502-268-5903

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  5403 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 61941373 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60054038 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".