Healthcare Provider Details

I. General information

NPI: 1730485715
Provider Name (Legal Business Name): DEVON BYRNE CONKLIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 KENILWORTH DR SUITE 102
TOWSON MD
21204-2101
US

IV. Provider business mailing address

1104 KENILWORTH DR SUITE 102
TOWSON MD
21204-2101
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-7010
  • Fax:
Mailing address:
  • Phone: 410-583-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14559
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: