Provider Demographics
NPI:1184696874
Name:CONQUEST, MATTHEW JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:CONQUEST
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:1187 THORN RUN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3198
Mailing Address - Country:US
Mailing Address - Phone:412-264-8440
Mailing Address - Fax:412-264-8441
Practice Address - Street 1:1187 THORN RUN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-3198
Practice Address - Country:US
Practice Address - Phone:412-264-8440
Practice Address - Fax:412-264-8441
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2016-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PADS036534122300000X, 1223S0112X
PADA031677207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology