Provider Demographics
NPI:1679794994
Name:CONNOR, MICHAEL S (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:CONNOR
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 1:1555 CROSS CREEKS BLVD
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8237
Mailing Address - Country:US
Mailing Address - Phone:614-866-2895
Mailing Address - Fax:614-866-3533
Practice Address - Street 1:1555 CROSS CREEKS BLVD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8237
Practice Address - Country:US
Practice Address - Phone:614-866-2895
Practice Address - Fax:614-866-3533
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist