Healthcare Provider Details

I. General information

NPI: 1760555353
Provider Name (Legal Business Name): DANIEL JAMES O'CONNOR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7115 CADE RD
BROWN CITY MI
48416-9778
US

IV. Provider business mailing address

7115 CADE RD
BROWN CITY MI
48416-9778
US

V. Phone/Fax

Practice location:
  • Phone: 810-989-0182
  • Fax: 810-346-2016
Mailing address:
  • Phone: 810-989-0182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5315008096
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: