Provider Demographics
NPI:1164504593
Name:O'CONNOR, RODNEY EARL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:EARL
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 BEAHAN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-3403
Mailing Address - Country:US
Mailing Address - Phone:585-436-1640
Mailing Address - Fax:585-436-5969
Practice Address - Street 1:521 BEAHAN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-3403
Practice Address - Country:US
Practice Address - Phone:585-436-1640
Practice Address - Fax:585-436-5969
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0317421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00482540Medicaid
NY7252OtherBLUE CROSS BLUE SHEILD