Provider Demographics
NPI:1942780663
Name:CONGER, ABIGAIL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:M
Last Name:CONGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 TIERNEY DR
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2329
Mailing Address - Country:US
Mailing Address - Phone:515-570-6692
Mailing Address - Fax:
Practice Address - Street 1:1000 QUINN DR
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2501
Practice Address - Country:US
Practice Address - Phone:608-849-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001914-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1001914-15OtherSTATE LICENSE NUMBER