Provider Demographics
NPI:1093445470
Name:CONCA, ROBERT ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:CONCA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 COLUMBUS AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5155
Mailing Address - Country:US
Mailing Address - Phone:845-240-4537
Mailing Address - Fax:
Practice Address - Street 1:TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE
Practice Address - Street 2:1 KNEELAND STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-6828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN1859567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program