Provider Demographics
NPI:1932487592
Name:CONRAD, GREGG A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGG
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 1:315 W 57TH ST
Mailing Address - Street 2:SUITE 409
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3158
Mailing Address - Country:US
Mailing Address - Phone:212-333-5003
Mailing Address - Fax:212-247-2491
Practice Address - Street 1:315 W 57TH ST
Practice Address - Street 2:SUITE 409
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3158
Practice Address - Country:US
Practice Address - Phone:212-333-5003
Practice Address - Fax:212-247-2491
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035017122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist