Provider Demographics
NPI:1073670592
Name:OCONNELL, MICHAEL G (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:OCONNELL
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:PO BOX 44594
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53744-4549
Mailing Address - Country:US
Mailing Address - Phone:608-238-3800
Mailing Address - Fax:608-238-5648
Practice Address - Street 1:310 N MIDVALE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705
Practice Address - Country:US
Practice Address - Phone:608-238-3800
Practice Address - Fax:608-238-5648
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4259122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist