Provider Demographics
NPI:1891828505
Name:CONRAD, MICHAEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:CONRAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3243
Mailing Address - Street 2:
Mailing Address - City:WESCOSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18106-0243
Mailing Address - Country:US
Mailing Address - Phone:610-398-1435
Mailing Address - Fax:
Practice Address - Street 1:770 FETTERS LN
Practice Address - Street 2:
Practice Address - City:WESCOSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18106-9290
Practice Address - Country:US
Practice Address - Phone:610-398-1435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023035L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice