Provider Demographics
NPI:1073653549
Name:CONWAY, SUZANNE TILLERY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:TILLERY
Last Name:CONWAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 7TH TER
Mailing Address - Street 2:SUITE 303
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6528
Mailing Address - Country:US
Mailing Address - Phone:772-569-4118
Mailing Address - Fax:772-569-9446
Practice Address - Street 1:3755 7TH TER
Practice Address - Street 2:SUITE 303
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6528
Practice Address - Country:US
Practice Address - Phone:772-569-4118
Practice Address - Fax:772-569-9446
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice