Provider Demographics
NPI:1467658351
Name:TERESA G. CONLEY, DDS, PA
Entity Type:Organization
Organization Name:TERESA G. CONLEY, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:910-326-2030
Mailing Address - Street 1:1306 WEST CORBETT AVE
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8464
Mailing Address - Country:US
Mailing Address - Phone:910-326-2030
Mailing Address - Fax:910-326-3192
Practice Address - Street 1:1306 W CORBETT AVE
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8464
Practice Address - Country:US
Practice Address - Phone:910-326-2030
Practice Address - Fax:910-326-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223D0001X
NC66601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990048Medicaid
NC89-90048Medicaid
969107OtherUNITED CONCORDIA
NC90048OtherBCBS