Provider Demographics
NPI:1417482068
Name:CHRISTOPHER O'KANE DDS INC.
Entity Type:Organization
Organization Name:CHRISTOPHER O'KANE DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:O'KANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-631-2515
Mailing Address - Street 1:124 COLFAX AVE SW
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482
Mailing Address - Country:US
Mailing Address - Phone:218-631-2515
Mailing Address - Fax:218-632-2517
Practice Address - Street 1:124 COLFAX AVE SW
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1468
Practice Address - Country:US
Practice Address - Phone:218-631-2515
Practice Address - Fax:218-632-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty