1265586937 NPI number — CONKEY MOBERGER PATEL DENTISTRY PARTNERSHIP LLC

Table of content: (NPI 1265586937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265586937 NPI number — CONKEY MOBERGER PATEL DENTISTRY PARTNERSHIP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONKEY MOBERGER PATEL DENTISTRY PARTNERSHIP LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LEVY CONKEY MOBERGER DENTISTRY PARTNERSHIP
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265586937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 N. HAMILTON RD.
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
GAHANNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43230-8710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-476-6696
Provider Business Mailing Address Fax Number:
614-476-5366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 N. HAMILTON RD.
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
GAHANNA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43230-8710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-476-6696
Provider Business Practice Location Address Fax Number:
614-476-5366
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CONKEY
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
ALBERT
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
614-476-6696

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  30020174 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 30019963 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 30019663 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 3002219 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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