Provider Demographics
NPI:1235913872
Name:CONIAM DENTAL LLC
Entity Type:Organization
Organization Name:CONIAM DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONIAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-510-9838
Mailing Address - Street 1:10752 W PRICKLY PEAR TRL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-9691
Mailing Address - Country:US
Mailing Address - Phone:602-510-9838
Mailing Address - Fax:
Practice Address - Street 1:15341 W WADDELL RD STE B-107
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-5169
Practice Address - Country:US
Practice Address - Phone:623-233-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental