Provider Demographics
NPI:1801655857
Name:MCGOWAN, CONNOR (DMD)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6680 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-9382
Mailing Address - Country:US
Mailing Address - Phone:270-559-7265
Mailing Address - Fax:
Practice Address - Street 1:212 NE 2ND ST APT 201
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4069
Practice Address - Country:US
Practice Address - Phone:270-559-7265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK79111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery