Theresa Beth Conway, D.D.S.,M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

012367 Issued in GA

Practice address

2302 English Ivy Court
Smyrna, GA 30080

Phone

(404) 964-5511

NPI assigned

Apr 13, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174748560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2302 ENGLISH IVY COURT",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "30080",
            "telephone_number": "404-964-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2302 ENGLISH IVY COURT",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "30080",
            "telephone_number": "404-964-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONWAY",
        "first_name": "THERESA",
        "middle_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.,M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "GA",
            "license": "012367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "012367",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Smyrna, GA
• Providers in Smyrna, GA by specialty
• Periodontics in Georgia

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.