MEDICARE: JUSTIN NEAL CONDUFF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401418441	VA

General Provider Information

NPI Number	:	1164116414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN NEAL CONDUFF

Provider Business Mailing Address
First Line	:	PO BOX 113
Second Line	:
City	:	FLOYD
State	:	VA
Zip	:	24091-0113
Country	:	US
Telephone Number	:	540-745-4171
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 W MAIN ST
Second Line	:
City	:	FLOYD
State	:	VA
Zip	:	24091-2380
Country	:	US
Telephone Number	:	540-745-4171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	06/07/2023

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Directions to “ JUSTIN NEAL CONDUFF ” Practice Location

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