Provider Demographics
NPI:1366553976
Name:CONLON, DENNIS J (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:CONLON
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 1:900 UNIVERSITY BLVD N
Mailing Address - Street 2:MC - 75
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-9230
Mailing Address - Country:US
Mailing Address - Phone:904-253-2062
Mailing Address - Fax:904-253-1942
Practice Address - Street 1:1830 WEST 45TH STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208
Practice Address - Country:US
Practice Address - Phone:904-253-1783
Practice Address - Fax:904-924-1788
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11129122300000X
FLDN13683122300000X
GADN011129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0009699-00Medicaid