Provider Demographics
NPI:1356408843
Name:CONVERSE, CYNTHIA JEAN (DDS)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JEAN
Last Name:CONVERSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 CHAEL DRIVE NE
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-9215
Mailing Address - Country:US
Mailing Address - Phone:319-624-3190
Mailing Address - Fax:319-624-3502
Practice Address - Street 1:1101 5TH STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2904
Practice Address - Country:US
Practice Address - Phone:319-337-9996
Practice Address - Fax:319-688-9996
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA76411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice