Provider Demographics
NPI:1063418812
Name:CONARD, JOSEPH R (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:CONARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BROADVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3515
Mailing Address - Country:US
Mailing Address - Phone:828-452-1187
Mailing Address - Fax:825-452-5388
Practice Address - Street 1:20 BROADVIEW ROAD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3515
Practice Address - Country:US
Practice Address - Phone:828-452-1187
Practice Address - Fax:825-452-5388
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC48901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCV35841Medicare UPIN