Healthcare Provider Details

I. General information

NPI: 1417099334
Provider Name (Legal Business Name): STEPHEN JOSEPH CONRAD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203N. 32ND ST. SUITE E
PHOENIX AZ
85018
US

IV. Provider business mailing address

35021 N 27TH LN
PHOENIX AZ
85086-6664
US

V. Phone/Fax

Practice location:
  • Phone: 602-955-8760
  • Fax: 602-955-6076
Mailing address:
  • Phone: 623-518-3911
  • Fax: 623-518-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7151
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7151
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: