Provider Demographics
NPI:1780746156
Name:CONWAY, HUGH GERARD (DDS)
Entity type:Individual
Prefix:DR
First Name:HUGH
Middle Name:GERARD
Last Name:CONWAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 COUNTY ROAD 2175 E
Mailing Address - Street 2:
Mailing Address - City:SECOR
Mailing Address - State:IL
Mailing Address - Zip Code:61771-9564
Mailing Address - Country:US
Mailing Address - Phone:309-744-5204
Mailing Address - Fax:
Practice Address - Street 1:3609 GENERAL ELECTRIC RD
Practice Address - Street 2:SUITE A
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-8534
Practice Address - Country:US
Practice Address - Phone:309-664-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0207961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice