Provider Demographics
NPI:1841278223
Name:CONOVER, GARY H
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:H
Last Name:CONOVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 N ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1100
Mailing Address - Country:US
Mailing Address - Phone:316-636-2939
Mailing Address - Fax:316-636-2989
Practice Address - Street 1:2939 N ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1100
Practice Address - Country:US
Practice Address - Phone:316-636-2939
Practice Address - Fax:316-636-2989
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS47431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice