Provider Demographics
NPI:1083760987
Name:CARL B. CONRAD DDS LTD.
Entity Type:Organization
Organization Name:CARL B. CONRAD DDS LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:B
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-963-7767
Mailing Address - Street 1:7101 JANES AVE
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2321
Mailing Address - Country:US
Mailing Address - Phone:630-963-7767
Mailing Address - Fax:
Practice Address - Street 1:7101 JANES AVE
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2321
Practice Address - Country:US
Practice Address - Phone:630-963-7767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL142801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty