Organization
CONQUEST ORAL AND MAXILLOFACIAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW CONQUEST DMD (MEMBER/OWNER)
(412) 463-7048
Entity
Organization
Contact information
Practice address
1187 THORN RUN RD, SUITE 110, CORAOPOLIS, PA 15108-3198
(412) 463-7048
Mailing address
1187 THORN RUN RD, SUITE 110, CORAOPOLIS, PA 15108-3198
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
DS036534
PA
Other
Enumeration date
10/31/2014
Last updated
10/31/2014
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