Provider Demographics
NPI:1407061617
Name:CONLEY, CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:CONLEY
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 1:901 CAMPUS DRIVE
Mailing Address - Street 2:STE 304
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015
Mailing Address - Country:US
Mailing Address - Phone:650-756-1900
Mailing Address - Fax:
Practice Address - Street 1:901 CAMPUS DRIVE
Practice Address - Street 2:STE 304
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-9401
Practice Address - Country:US
Practice Address - Phone:650-756-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist