Provider Demographics
NPI:1588843247
Name:CONRAD, COREY CHRISTOPHER (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:CHRISTOPHER
Last Name:CONRAD
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5890 MORNING STAR CT.
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-2230
Mailing Address - Country:US
Mailing Address - Phone:515-266-2154
Mailing Address - Fax:515-266-8065
Practice Address - Street 1:5890 MORNING STAR CT.
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-2230
Practice Address - Country:US
Practice Address - Phone:515-266-2154
Practice Address - Fax:515-266-8065
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0247338Medicaid