Healthcare Provider Details

I. General information

NPI: 1285731091
Provider Name (Legal Business Name): KRISTINA GRABOWSKI CONNOR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N EXECUTIVE DR SUITE 105
BROOKFIELD WI
53005-6070
US

IV. Provider business mailing address

125 N. EXECUTIVE DR. SUITE 105
BROOKFIELD WI
53005
US

V. Phone/Fax

Practice location:
  • Phone: 262-784-7201
  • Fax:
Mailing address:
  • Phone: 262-784-7201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5645
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5641
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: