Provider Demographics
NPI:1437264694
Name:CONOVER, MARK EARL
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EARL
Last Name:CONOVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-1342
Mailing Address - Country:US
Mailing Address - Phone:507-931-1230
Mailing Address - Fax:507-931-1493
Practice Address - Street 1:402 SUNRISE DR
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-1342
Practice Address - Country:US
Practice Address - Phone:507-931-1230
Practice Address - Fax:507-931-1493
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN91281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice