Healthcare Provider Details

I. General information

NPI: 1407840382
Provider Name (Legal Business Name): TRENT PAUL CONELIAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6033 PROVIDENCE RD
VIRGINIA BEACH VA
23464-3815
US

IV. Provider business mailing address

6033 PROVIDENCE RD
VIRGINIA BEACH VA
23464-3815
US

V. Phone/Fax

Practice location:
  • Phone: 757-424-2672
  • Fax: 757-366-0482
Mailing address:
  • Phone: 757-424-2672
  • Fax: 757-366-0482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number029325L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number0401411285
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: