Provider Demographics
NPI:1801218524
Name:STAFFORD G CONLEY JR DDS PC
Entity Type:Organization
Organization Name:STAFFORD G CONLEY JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STAFFORD
Authorized Official - Middle Name:GARFIELD
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-218-2454
Mailing Address - Street 1:1540 POINTER RIDGE PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1881
Mailing Address - Country:US
Mailing Address - Phone:301-218-2454
Mailing Address - Fax:301-218-2455
Practice Address - Street 1:1540 POINTER RIDGE PL
Practice Address - Street 2:SUITE A
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1881
Practice Address - Country:US
Practice Address - Phone:301-218-2454
Practice Address - Fax:301-218-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD142311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty