MEDICARE: DR. LADAN A. CONVEY 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	122300000X	Dentist	7351	NE
2	122300000X	Dentist	41107	TX
3	122300000X	Dentist	0401410289	VA

General Provider Information

NPI Number	:	1881674935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LADAN A. CONVEY DDS

Provider Business Mailing Address
First Line	:	3133 TIERRA NORA
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-4307
Country	:	US
Telephone Number	:	931-494-4667
Fax Number	:

Provider Business Practice Location Address
First Line	:	3133 TIERRA NORA
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-4307
Country	:	US
Telephone Number	:	931-494-4667
Fax Number	:

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	01/23/2025

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