Provider Demographics
NPI:1891884730
Name:CONWAY, STEPHEN D (DDS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:D
Last Name:CONWAY
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 1:215 SUNSET RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1108
Mailing Address - Country:US
Mailing Address - Phone:609-877-1330
Mailing Address - Fax:609-877-8313
Practice Address - Street 1:215 SUNSET RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1108
Practice Address - Country:US
Practice Address - Phone:609-877-1330
Practice Address - Fax:609-877-8313
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ130931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice