Provider Demographics
NPI:1629156757
Name:CONANAN, CHRISTY MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:MARIE
Last Name:CONANAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:ALCOSEBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4747 N 1ST ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0563
Mailing Address - Country:US
Mailing Address - Phone:559-229-6249
Mailing Address - Fax:559-229-0342
Practice Address - Street 1:4747 N. FIRST ST.
Practice Address - Street 2:SUITE 109
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0563
Practice Address - Country:US
Practice Address - Phone:559-229-6249
Practice Address - Fax:559-229-0342
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist