Provider Demographics
NPI:1780269548
Name:CONNOR MCCANE DMD PLLC
Entity type:Organization
Organization Name:CONNOR MCCANE DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNOR
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCCANE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:616-340-6723
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty