Physician Compare National (NPI:1487668612)

HEALTHCARE PROVIDER: ROBERT CONLON D.D.S.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1487668612
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5698876985
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101020000984
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CONLON
	Individual professional last name
Provider First Name	ROBERT
	Individual professional first name
Provider Middle Name	K
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIV OF ILLINOIS AT CHICAGO COLLEGE OF DENTISTRY
	Individual professional's medical school
Graduation Year	1977
	Individual professional's medical school graduation year
Primary Specialty	ORAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	MAXILLOFACIAL SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	MAXILLOFACIAL SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	312 CTR ST
	Group Practice or individual's line 1 address
City	LAKE GENEVA
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	531471904
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y