Provider Demographics
NPI:1477744399
Name:OCONNOR, CANDACE (DDS)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:GAMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1547 S HIGGINS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4226
Mailing Address - Country:US
Mailing Address - Phone:406-549-2778
Mailing Address - Fax:406-728-6160
Practice Address - Street 1:1547 S HIGGINS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4226
Practice Address - Country:US
Practice Address - Phone:406-549-2778
Practice Address - Fax:406-728-6160
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT21731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice