Provider Demographics
NPI:1811212103
Name:CONRAD, ARNE', LOMBARDO, & KRUPA, D.D.S., P.A.
Entity Type:Organization
Organization Name:CONRAD, ARNE', LOMBARDO, & KRUPA, D.D.S., P.A.
Other - Org Name:COASTAL CAROLINA ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARNE'
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-762-1555
Mailing Address - Street 1:1510 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7506
Mailing Address - Country:US
Mailing Address - Phone:910-762-1555
Mailing Address - Fax:910-251-1721
Practice Address - Street 1:1510 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7506
Practice Address - Country:US
Practice Address - Phone:910-762-1555
Practice Address - Fax:910-251-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty