Provider Demographics
NPI:1801939285
Name:CONRAD, DAVID HARRY (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HARRY
Last Name:CONRAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1319
Mailing Address - Country:US
Mailing Address - Phone:614-876-1241
Mailing Address - Fax:614-876-1242
Practice Address - Street 1:3511 MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1319
Practice Address - Country:US
Practice Address - Phone:614-876-1241
Practice Address - Fax:614-876-1242
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice