MEDICARE: DR. TRENT PAUL CONELIAS DDS

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)	029325L	PA
2	1223P0106X	Oral and Maxillofacial Pathology Dentistry	0401411285	VA

General Provider Information

NPI Number	:	1407840382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRENT PAUL CONELIAS DDS

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	:	757-366-0482

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	:	757-366-0482

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	09/11/2025

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