Provider Demographics
NPI:1952344012
Name:CONDE, JOSE JUAN
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JUAN
Last Name:CONDE
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 1:8476 SIMONDS ST., SUITE 5700
Mailing Address - Street 2:US DENTAL ACTIVITY
Mailing Address - City:FORT MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-5700
Mailing Address - Country:US
Mailing Address - Phone:301-677-6122
Mailing Address - Fax:326-544-5903
Practice Address - Street 1:8476 SIMONDS ST., SUITE 5700
Practice Address - Street 2:US DENTAL ACTIVITY
Practice Address - City:FORT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-5700
Practice Address - Country:US
Practice Address - Phone:301-677-6122
Practice Address - Fax:326-544-5903
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 130131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice