Provider Demographics
NPI:1881700763
Name:O'KANE, CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:O'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 1:124 COLFAX AVE SW
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1468
Mailing Address - Country:US
Mailing Address - Phone:218-631-2515
Mailing Address - Fax:218-632-2517
Practice Address - Street 1:124 COLFAX AVE SW
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1468
Practice Address - Country:US
Practice Address - Phone:218-631-2515
Practice Address - Fax:218-632-2517
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN51Q860KOtherBCBS
277827OtherUNITED CONCORDIA