Provider Demographics
NPI:1770653651
Name:KANE, JOHN M (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:KANE
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:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:BIRCHWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54817-0250
Mailing Address - Country:US
Mailing Address - Phone:715-354-3369
Mailing Address - Fax:715-354-7158
Practice Address - Street 1:108 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:BIRCHWOOD
Practice Address - State:WI
Practice Address - Zip Code:54817
Practice Address - Country:US
Practice Address - Phone:715-354-3369
Practice Address - Fax:715-354-7158
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5702122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist