Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 0401411285 | VA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 029325L | PA |
NPI | 1407840382 |
---|---|
Provider Name | Dr. Trent Paul Conelias |
First Address | Virginia Beach, VA 23464-3815 |
Second Address | Virginia Beach, VA 23464-3815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U57941 | (02) | PA |