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General NPI Number Information
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NPI Number | 1801218524
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Entity Type | Organization
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Legal Business Name | STAFFORD G CONLEY JR DDS PC
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 1540 POINTER RIDGE PL SUITE A
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City | BOWIE
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State | MD
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Zip | 20716-1881
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Country | US
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Telephone | 301-218-2454
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Fax | 301-218-2455
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Provider Business Mailing Address
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Address Line | 1540 POINTER RIDGE PL SUITE A
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City | BOWIE
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State | MD
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Zip | 20716-1881
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Country | US
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Telephone | 301-218-2454
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Fax | 301-218-2455
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Authorized Official
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Title or Position | OWNER
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Name | DR. STAFFORD GARFIELD CONLEY JR.
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Credential | DDS
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Telephone | 301-218-2454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14231
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License Number State | MD
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