Provider Demographics
NPI:1346422557
Name:CONWAY ORCHID LLC
Entity Type:Organization
Organization Name:CONWAY ORCHID LLC
Other - Org Name:ORCHID DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:772-581-9597
Mailing Address - Street 1:9301 HIGHWAY A1A
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-4500
Mailing Address - Country:US
Mailing Address - Phone:772-581-9597
Mailing Address - Fax:772-581-3664
Practice Address - Street 1:9301 HIGHWAY A1A
Practice Address - Street 2:SUITE 101
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-4500
Practice Address - Country:US
Practice Address - Phone:772-581-9597
Practice Address - Fax:772-581-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL84921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty