Provider Demographics
NPI:1164646121
Name:O'CONNOR, MICHAEL T (DDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:O'CONNOR
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 1:1 FLAGLAR DR
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1314
Mailing Address - Country:US
Mailing Address - Phone:518-563-3112
Mailing Address - Fax:518-563-8623
Practice Address - Street 1:55 CORNELIA ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1853
Practice Address - Country:US
Practice Address - Phone:518-563-8622
Practice Address - Fax:518-563-8623
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0333881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice