Provider Demographics
NPI:1295410843
Name:CONTO, ETHAN (DMD)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:CONTO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:CHICORA
Mailing Address - State:PA
Mailing Address - Zip Code:16025-0375
Mailing Address - Country:US
Mailing Address - Phone:724-445-2558
Mailing Address - Fax:
Practice Address - Street 1:2016 CHICORA RD
Practice Address - Street 2:
Practice Address - City:CHICORA
Practice Address - State:PA
Practice Address - Zip Code:16025-3018
Practice Address - Country:US
Practice Address - Phone:725-445-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0441561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice