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General NPI Number Information
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NPI Number | 1114231123
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Entity Type | Individual
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Provider Name | ALBERT TERRENCE CONLISK III DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1976 GRANVILLE RD
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City | NEWARK
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State | OH
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Zip | 43055-9799
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Country | US
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Telephone | 740-231-2121
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Fax | 740-231-5255
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Provider Business Mailing Address
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Address Line | 1976 GRANVILLE RD
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City | NEWARK
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State | OH
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Zip | 43055-9799
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Country | US
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Telephone | 740-231-2121
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Fax | 740-231-5255
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2901020233
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 30.24776
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License Number State | OH
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