Provider Demographics
NPI:1912072026
Name:OCONNOR, PATRICK A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:OCONNOR
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 1:630 S RANCHO DR
Mailing Address - Street 2:STE B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106
Mailing Address - Country:US
Mailing Address - Phone:702-870-2555
Mailing Address - Fax:702-870-4997
Practice Address - Street 1:630 S RANCHO DR
Practice Address - Street 2:STE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-870-2555
Practice Address - Fax:702-870-4997
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2601S2181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2202761Medicaid
NV2202761Medicaid
DDS2601Medicare ID - Type Unspecified