MEDICARE: DR. NICHOLAS JAMES CONLEY D.D.S.

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	DE60665022	WA

General Provider Information

NPI Number	:	1588113336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS JAMES CONLEY D.D.S.

Provider Business Mailing Address
First Line	:	12806 3RD AVE SE
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98208-6455
Country	:	US
Telephone Number	:	425-338-0666
Fax Number	:

Provider Business Practice Location Address
First Line	:	12806 3RD AVE SE
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98208-6455
Country	:	US
Telephone Number	:	425-338-0666
Fax Number	:

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

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	09/21/2016

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