Provider Demographics
NPI:1528173234
Name:CONNOR, MICHAEL SCOTT (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:CONNOR
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Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-547-8665
Mailing Address - Fax:262-547-4328
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 222
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-547-8665
Practice Address - Fax:262-547-4328
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2011-01-13
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Provider Licenses
StateLicense IDTaxonomies
WI55780151223S0112X
WI48605204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery