Healthcare Provider Details

I. General information

NPI: 1255663019
Provider Name (Legal Business Name): MARK CONARD D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4382 OLEANDER DRIVE
MYRTLE BEACH SC
29577
US

IV. Provider business mailing address

4382 OLEANDER DR
MYRTLE BEACH SC
29577-5717
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8856
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-023157
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4617
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: