Basic Information
| Provider Information | |||||||||
| NPI: | 1982207668 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DANIEL J O'CONNOR DDS PLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 7115 CADE RD | ||||||||
| Address2: | |||||||||
| City: | BROWN CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484169778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103462758 | ||||||||
| FaxNumber: | 8103462016 | ||||||||
| Practice Location | |||||||||
| Address1: | 7115 CADE RD | ||||||||
| Address2: | |||||||||
| City: | BROWN CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484169778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103462758 | ||||||||
| FaxNumber: | 8103462016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2020 | ||||||||
| LastUpdateDate: | 11/17/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | O'CONNOR | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | DR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8103462758 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | DDS | ||||||||
| NPICertificationDate: | 11/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.