Provider Demographics
NPI:1508419342
Name:MCCANE, CONNOR MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:MICHAEL
Last Name:MCCANE
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 1:8333 WOODCREST DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8507
Mailing Address - Country:US
Mailing Address - Phone:616-340-6723
Mailing Address - Fax:
Practice Address - Street 1:215 S CENTER ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MI
Practice Address - Zip Code:48884-9301
Practice Address - Country:US
Practice Address - Phone:989-291-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist