Healthcare Provider Details

I. General information

NPI: 1093628034
Provider Name (Legal Business Name): WALTER KONRAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48853 CALCUTTA SMITHFERRY RD
EAST LIVERPOOL OH
43920-9639
US

IV. Provider business mailing address

210 PARKER DR
PITTSBURGH PA
15216-1310
US

V. Phone/Fax

Practice location:
  • Phone: 330-385-6216
  • Fax:
Mailing address:
  • Phone: 412-938-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028638
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: