Active NPI
Suzanne Tillery Conway, D.D.S.
- General Practice Dentistry
- Vero Beach, FL
National Provider Identifier
1073653549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 9340
- Practice address
- 3755 7TH Ter
Suite 303
Vero Beach, FL 32960-6528 - Phone
- (772) 569-4118
- Fax
- (772) 569-9446
- NPI assigned
- Feb 7, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9340 | FL | Primary |
Addresses
Primary practice location
3755 7TH Ter
Suite 303
Vero Beach, FL 32960-6528
Mailing address
3755 7TH Ter
Suite 303
Vero Beach, FL 32960-6528
Phone (772) 569-4118
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 17, 2016 through May 17, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9340 | FL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073653549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3755 7TH TER",
"address_2": "SUITE 303",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "329606528",
"telephone_number": "772-569-4118",
"fax_number": "772-569-9446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3755 7TH TER",
"address_2": "SUITE 303",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "329606528",
"telephone_number": "772-569-4118",
"fax_number": "772-569-9446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONWAY",
"first_name": "SUZANNE",
"middle_name": "TILLERY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "9340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vero Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.