Provider Demographics
NPI:1891801957
Name:CONNOR, J DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:DENNIS
Last Name:CONNOR
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 66
Mailing Address - Street 2:
Mailing Address - City:KEWASKUM
Mailing Address - State:WI
Mailing Address - Zip Code:53040-0066
Mailing Address - Country:US
Mailing Address - Phone:262-626-2119
Mailing Address - Fax:262-626-2110
Practice Address - Street 1:1204 FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:KEWASKUM
Practice Address - State:WI
Practice Address - Zip Code:53040-8954
Practice Address - Country:US
Practice Address - Phone:262-626-2119
Practice Address - Fax:262-626-2110
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist