Provider Demographics
NPI:1427180728
Name:CONLEY, JAMES ANDREW (DDS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANDREW
Last Name:CONLEY
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 1:4625 N LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-9120
Mailing Address - Country:US
Mailing Address - Phone:209-617-3827
Mailing Address - Fax:209-579-9521
Practice Address - Street 1:909 W ROSEBURG AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5028
Practice Address - Country:US
Practice Address - Phone:209-526-3815
Practice Address - Fax:209-579-9521
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43926OtherDDS LICENSE
CABC6445185OtherDEA