Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 13859 | OH |
NPI | 1003046269 |
---|---|
Provider Name | Charles R Conroy |
First Address | New Albany, OH 43054 |
Second Address | New Albany, OH 43054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2009 |
Last Update Date | 22/07/2009 |