Provider Demographics
NPI:1154805463
Name:CONLEY DENTAL CORPORATION
Entity type:Organization
Organization Name:CONLEY DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:415-347-7177
Mailing Address - Street 1:89 TEDDY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-2345
Mailing Address - Country:US
Mailing Address - Phone:415-347-7177
Mailing Address - Fax:
Practice Address - Street 1:901 CAMPUS DR STE 304
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4930
Practice Address - Country:US
Practice Address - Phone:650-756-1900
Practice Address - Fax:650-756-9287
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONLEY DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental