Provider Demographics
NPI:1144415670
Name:OCONNOR, EDWARD CARL (DDS PA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:CARL
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WALDROUP ROAD
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904
Mailing Address - Country:US
Mailing Address - Phone:828-389-8714
Mailing Address - Fax:828-389-8379
Practice Address - Street 1:36 WALDROUP ROAD
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904
Practice Address - Country:US
Practice Address - Phone:828-389-8714
Practice Address - Fax:828-389-8379
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist