Provider Demographics
NPI:1184777435
Name:CONNOR, MICHAEL F (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
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:S109W34791 JACKS BAY RD
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9505
Mailing Address - Country:US
Mailing Address - Phone:262-594-2612
Mailing Address - Fax:262-363-3908
Practice Address - Street 1:603 N ROCHESTER STREET
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149
Practice Address - Country:US
Practice Address - Phone:262-363-4041
Practice Address - Fax:262-363-3908
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50000890G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice