Provider Demographics
NPI:1275713505
Name:CONLEY, STAFFORD GARFIELD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:STAFFORD
Middle Name:GARFIELD
Last Name:CONLEY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 POINTER RIDGE PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1881
Mailing Address - Country:US
Mailing Address - Phone:301-218-2454
Mailing Address - Fax:301-218-2455
Practice Address - Street 1:1540 POINTER RIDGE PL
Practice Address - Street 2:SUITE A
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1881
Practice Address - Country:US
Practice Address - Phone:301-218-2454
Practice Address - Fax:301-218-2455
Is Sole Proprietor?:No
Enumeration Date:2007-11-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22948122300000X
MD14231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist