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General NPI Number Information
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NPI Number | 1629460951
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Entity Type | Individual
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Provider Name | MARK CONOVER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/24/2015
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 44100 JEFFERSON ST # 506
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City | INDIO
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State | CA
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Zip | 92201-9014
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Country | US
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Telephone | 951-217-4625
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Fax |
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Provider Business Mailing Address
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Address Line | 30975 E SUNSET DR S
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City | REDLANDS
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State | CA
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Zip | 92373-7449
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Country | US
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Telephone |
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Fax |
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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 | DD3892
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License Number State | NM
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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 | 28914
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License Number State | CA
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