Provider Demographics
NPI:1265586937
Name:CONKEY MOBERGER PATEL DENTISTRY PARTNERSHIP LLC
Entity type:Organization
Organization Name:CONKEY MOBERGER PATEL DENTISTRY PARTNERSHIP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:CONKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-476-6696
Mailing Address - Street 1:925 N. HAMILTON RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8710
Mailing Address - Country:US
Mailing Address - Phone:614-476-6696
Mailing Address - Fax:614-476-5366
Practice Address - Street 1:925 N. HAMILTON RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-8710
Practice Address - Country:US
Practice Address - Phone:614-476-6696
Practice Address - Fax:614-476-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300199631223G0001X
OH300196631223G0001X
OH30022191223G0001X
OH300201741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty