Provider Demographics
NPI:1952444838
Name:CONWAY, ROBERT E (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
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 1:395 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3614
Mailing Address - Country:US
Mailing Address - Phone:570-288-6561
Mailing Address - Fax:570-287-3248
Practice Address - Street 1:395 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3614
Practice Address - Country:US
Practice Address - Phone:570-288-6561
Practice Address - Fax:570-287-3248
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-16134-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice