Provider Demographics
NPI:1386990729
Name:CONKIN, ANDREW DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DAVID
Last Name:CONKIN
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 1:1109 N EASTMAN RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-3156
Mailing Address - Country:US
Mailing Address - Phone:423-245-9071
Mailing Address - Fax:423-245-9474
Practice Address - Street 1:1109 N EASTMAN RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-3156
Practice Address - Country:US
Practice Address - Phone:423-245-9071
Practice Address - Fax:423-245-9474
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000095421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice