Provider Demographics
NPI:1912041161
Name:CONFORTI, RICHARD BROWN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BROWN
Last Name:CONFORTI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 S COURTENAY PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4888
Mailing Address - Country:US
Mailing Address - Phone:321-452-8767
Mailing Address - Fax:321-452-8769
Practice Address - Street 1:195 S COURTENAY PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4888
Practice Address - Country:US
Practice Address - Phone:321-452-8767
Practice Address - Fax:321-452-8769
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL80391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice