Provider Demographics
NPI:1033251103
Name:CONLEY, ROBERT OTTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:OTTO
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 1:3930 KNOWLES AVE
Mailing Address - Street 2:204
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2428
Mailing Address - Country:US
Mailing Address - Phone:301-942-2611
Mailing Address - Fax:301-942-2603
Practice Address - Street 1:2112 F ST NW
Practice Address - Street 2:SUITE203
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2715
Practice Address - Country:US
Practice Address - Phone:202-466-3364
Practice Address - Fax:202-466-3365
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD70061223G0001X
DCDEN35501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice