Provider Demographics
NPI:1568472223
Name:CONICELLI, KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:CONICELLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E GRASSY SPRAIN RD
Mailing Address - Street 2:SUITE 304A
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-4620
Mailing Address - Country:US
Mailing Address - Phone:914-337-2618
Mailing Address - Fax:914-337-2783
Practice Address - Street 1:35 E GRASSY SPRAIN RD
Practice Address - Street 2:SUITE 304A
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-4620
Practice Address - Country:US
Practice Address - Phone:914-337-2618
Practice Address - Fax:914-337-2783
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0326771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice