Healthcare Provider Details

I. General information

NPI: 1598776676
Provider Name (Legal Business Name): CONWAY & MATHEWS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 THONOTOSASSA RD STE A
PLANT CITY FL
33563-2972
US

IV. Provider business mailing address

2005 THONOTOSASSA RD STE A
PLANT CITY FL
33563-2972
US

V. Phone/Fax

Practice location:
  • Phone: 813-754-3794
  • Fax: 813-754-1677
Mailing address:
  • Phone: 813-754-3794
  • Fax: 813-754-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAMELA D CONWAY
Title or Position: DS
Credential: RDH
Phone: 813-754-3794