Healthcare Provider Details

I. General information

NPI: 1265929913
Provider Name (Legal Business Name): TRENT P CONELIAS DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
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:
Mailing address:
  • Phone: 757-424-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateVA

VIII. Authorized Official

Name: MRS. LAURA SHAWVER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 757-424-2672