Provider Demographics
NPI:1366825762
Name:CONKLIN & WARD DENTAL GROUP, PA
Entity Type:Organization
Organization Name:CONKLIN & WARD DENTAL GROUP, PA
Other - Org Name:WARD, BYRNE AND CONKLIN DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-921-9504
Mailing Address - Street 1:1104 KENILWORTH DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3104
Mailing Address - Country:US
Mailing Address - Phone:410-583-7010
Mailing Address - Fax:410-583-2272
Practice Address - Street 1:1104 KENILWORTH DR STE 102
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-3104
Practice Address - Country:US
Practice Address - Phone:410-583-7010
Practice Address - Fax:410-583-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty