Provider Demographics
NPI:1649389503
Name:CONLEY, DANTE MARIA (MD)
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:MARIA
Last Name:CONLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANTE
Other - Middle Name:MARIA
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1001 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4922
Mailing Address - Country:US
Mailing Address - Phone:907-459-3500
Mailing Address - Fax:907-458-2699
Practice Address - Street 1:1001 NOBLE ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4922
Practice Address - Country:US
Practice Address - Phone:907-459-3500
Practice Address - Fax:907-458-2699
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60024758208600000X
AK7729208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1584104Medicaid
AK0361450001Medicare NSC
AK1584104Medicaid