MEDICARE: ZACHARY RYAN CONLEY 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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	061399-01	NY

General Provider Information

NPI Number	:	1689237034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY RYAN CONLEY DDS

Provider Business Mailing Address
First Line	:	3057 ROUTE 50
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3057 ROUTE 50
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2956
Country	:	US
Telephone Number	:	518-907-0409
Fax Number	:

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

Provider Enumeration Date	:	04/20/2019
Last Update Date	:	10/15/2020

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