Provider Demographics
NPI:1356375661
Name:CONROY, KEVIN P (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
Last Name:CONROY
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 1:1540 LAKE ELMO DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1797
Mailing Address - Country:US
Mailing Address - Phone:406-252-4200
Mailing Address - Fax:406-252-9002
Practice Address - Street 1:1540 LAKE ELMO DR
Practice Address - Street 2:SUITE #2
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-1797
Practice Address - Country:US
Practice Address - Phone:406-252-4200
Practice Address - Fax:406-252-9002
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT129155Medicaid