Individual
DR. CHARLES E CONKLIN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2017 JEFFERSON ST SW, CARILION DENTAL CLINIC, ROANOKE, VA 24014-2419
(540) 981-7128
Mailing address
4569 KEAGY RD, ROANOKE, VA 24018-7417
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0401-004990
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805225
—
VA
05
—
7816146
—
VA
Enumeration date
03/10/2006
Last updated
04/30/2008
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