MEDICARE: TRENT P CONELIAS DDS, PC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)		VA

General Provider Information

NPI Number	:	1265929913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRENT P CONELIAS DDS, PC

Provider Business Mailing Address
First Line	:	6033 PROVIDENCE RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3815
Country	:	US
Telephone Number	:	757-424-2672
Fax Number	:

Provider Business Practice Location Address
First Line	:	6033 PROVIDENCE RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3815
Country	:	US
Telephone Number	:	757-424-2672
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. LAURA SHAWVER
Credential	:
Telephone Number	:	757-424-2672

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	04/23/2024

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