Provider Demographics
NPI:1760610992
Name:CONNOR, KATHRYN COURY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:COURY
Last Name:CONNOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:JANINE
Other - Last Name:COURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:300 E SUMMIT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:WI
Mailing Address - Zip Code:53183-9664
Mailing Address - Country:US
Mailing Address - Phone:262-201-4718
Mailing Address - Fax:
Practice Address - Street 1:300 E SUMMIT AVE STE C
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:WI
Practice Address - Zip Code:53183-9664
Practice Address - Country:US
Practice Address - Phone:262-201-4718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA60281223G0001X
390200000X
WI67981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program