Healthcare Provider Details

I. General information

NPI: 1538273420
Provider Name (Legal Business Name): THOMAS OLIVER CONLON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12509 E MISSION AVE SUITE 203
SPOKANE VALLEY WA
99216-1049
US

IV. Provider business mailing address

12509 E MISSION AVE SUITE 203
SPOKANE VALLEY WA
99216-1049
US

V. Phone/Fax

Practice location:
  • Phone: 509-928-6464
  • Fax: 509-924-8892
Mailing address:
  • Phone: 509-928-6464
  • Fax: 509-924-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE00003792
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: