Provider Demographics
NPI:1104316637
Name:JOHN F. CONAGHAN, D.D.S.
Entity type:Organization
Organization Name:JOHN F. CONAGHAN, D.D.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-654-1777
Mailing Address - Street 1:8218 WISCONSIN AVE STE 317
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3107
Mailing Address - Country:US
Mailing Address - Phone:301-654-1777
Mailing Address - Fax:301-654-5369
Practice Address - Street 1:8218 WISCONSIN AVE STE 317
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3107
Practice Address - Country:US
Practice Address - Phone:301-654-1777
Practice Address - Fax:301-654-5369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty