Provider Demographics
NPI:1609117803
Name:CONLEY & AZARNOUSH P.C.
Entity Type:Organization
Organization Name:CONLEY & AZARNOUSH P.C.
Other - Org Name:MOSAIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:SUSANNE
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-528-0975
Mailing Address - Street 1:1460 E WHITESTONE BLVD
Mailing Address - Street 2:STE. 210
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2210
Mailing Address - Country:US
Mailing Address - Phone:512-528-0975
Mailing Address - Fax:512-528-0184
Practice Address - Street 1:1460 E WHITESTONE BLVD
Practice Address - Street 2:STE. 210
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2210
Practice Address - Country:US
Practice Address - Phone:512-528-0975
Practice Address - Fax:512-528-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty