Provider Demographics
NPI:1568475036
Name:CONRAD, JOHN FREDERICK (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:CONRAD
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 1:2817 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2313
Mailing Address - Country:US
Mailing Address - Phone:510-848-8606
Mailing Address - Fax:510-848-0844
Practice Address - Street 1:2300 DURANT AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1607
Practice Address - Country:US
Practice Address - Phone:510-848-8606
Practice Address - Fax:510-848-0844
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD21441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist