Albert Terrence Conlisk III, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

30.24776 Issued in OH

Practice address

1976 Granville Rd
Newark, OH 43055-9799

Phone

(740) 231-2121

Fax

(740) 231-5255

NPI assigned

Aug 2, 2010

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1114231123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1976 GRANVILLE RD",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430559799",
            "telephone_number": "740-231-2121",
            "fax_number": "740-231-5255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1976 GRANVILLE RD",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430559799",
            "telephone_number": "740-231-2121",
            "fax_number": "740-231-5255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1575 Cross Creeks Blvd",
            "address_purpose": "LOCATION",
            "city": "Pickerington",
            "state": "OH",
            "postal_code": "431478237",
            "country_code": "US",
            "telephone_number": "614-751-7500",
            "fax_number": "614-322-7900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONLISK",
        "first_name": "ALBERT",
        "middle_name": "TERRENCE",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-02",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901020233",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "30.24776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Heather Anne Conkle
• Stormie Conklin, CDCA
• Linzie M Conn, PT
• Consumer Support Services, Inc.
• Carolann Ithica Conway
• Heather L Cook
• Johanna Lucy Cook, MD

• Oral and Maxillofacial Surgery (Dentist) in Newark, OH
• Providers in Newark, OH by specialty
• Oral and Maxillofacial Surgery (Dentist) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.