Provider Demographics
NPI:1275652737
Name:CONAGHAN, PATRICK EDWARD (DMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:EDWARD
Last Name:CONAGHAN
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:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14231
Mailing Address - Country:US
Mailing Address - Phone:716-204-4999
Mailing Address - Fax:716-632-2963
Practice Address - Street 1:840 N KINZIE AVE
Practice Address - Street 2:STE B
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915
Practice Address - Country:US
Practice Address - Phone:815-936-9941
Practice Address - Fax:815-836-6161
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38825122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist