Provider Demographics
NPI:1447737911
Name:CONLEY, MATTHEW B (DMD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:B
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:PO BOX 953
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33975-0953
Mailing Address - Country:US
Mailing Address - Phone:863-517-1272
Mailing Address - Fax:
Practice Address - Street 1:55 BELMONT ST
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4789
Practice Address - Country:US
Practice Address - Phone:863-675-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist