Individual
KEVIN JAMES CONNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.
Contact information
Practice address
1111 DELAFIELD STREET, SUITE 222, WAUKESHA, WI 53188-3403
(262) 547-8665
(262) 547-8685
Mailing address
1111 DELAFIELD STREET, SUITE 222, WAUKESHA, WI 53188-3403
(262) 547-8665
(262) 547-8685
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6201 54630
WI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
S-406
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07054
—
LA
Enumeration date
05/23/2007
Last updated
07/19/2010
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