Provider Demographics
NPI:1225205487
Name:CONLEY, MARVIN W (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:W
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 1:1260 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-3242
Mailing Address - Country:US
Mailing Address - Phone:775-738-8117
Mailing Address - Fax:775-738-2083
Practice Address - Street 1:1260 6TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3242
Practice Address - Country:US
Practice Address - Phone:775-738-8117
Practice Address - Fax:775-738-2083
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV0701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist