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General NPI Number Information
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NPI Number | 1659499325
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Entity Type | Organization
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Legal Business Name | MARK A. CONOVER DDS MS APC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/04/2013
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Provider Practice Location Address
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Address Line | 255 N GILBERT ST STE A
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City | HEMET
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State | CA
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Zip | 92543-4066
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Country | US
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Telephone | 951-652-2474
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Fax |
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Provider Business Mailing Address
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Address Line | 255 N GILBERT ST STE A
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City | HEMET
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State | CA
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Zip | 92543-4066
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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 | PRESIDENT
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Name | MARK CONOVER
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Credential |
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Telephone | 951-652-2474
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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 | 28914
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License Number State | CA
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