Provider Demographics
NPI:1659095412
Name:CONWAY DDS INC.
Entity Type:Organization
Organization Name:CONWAY DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAIVYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-477-1184
Mailing Address - Street 1:PO BOX 501265
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-1265
Mailing Address - Country:US
Mailing Address - Phone:619-807-8710
Mailing Address - Fax:619-474-4948
Practice Address - Street 1:9750 MIRAMAR RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4561
Practice Address - Country:US
Practice Address - Phone:858-271-7440
Practice Address - Fax:858-271-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty