Provider Demographics
NPI:1659050243
Name:DRANGSHOLT, CONNOR JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:JAMES
Last Name:DRANGSHOLT
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 1:9618 59TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2799
Mailing Address - Country:US
Mailing Address - Phone:253-584-2124
Mailing Address - Fax:
Practice Address - Street 1:9618 59TH AVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2799
Practice Address - Country:US
Practice Address - Phone:253-584-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE614551471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice