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General NPI Number Information
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NPI Number | 1184696874
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Entity Type | Individual
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Provider Name | MATTHEW JOHN CONQUEST DMD
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Gender | Male
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 1187 THORN RUN RD SUITE 110
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City | CORAOPOLIS
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State | PA
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Zip | 15108-3198
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Country | US
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Telephone | 412-264-8440
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Fax | 412-264-8441
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Provider Business Mailing Address
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Address Line | 1187 THORN RUN RD SUITE 110
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City | CORAOPOLIS
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State | PA
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Zip | 15108-3198
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Country | US
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Telephone | 412-264-8440
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Fax | 412-264-8441
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DS036534
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License Number State | PA
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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 | DS036534
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | DA031677
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License Number State | PA
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