Healthcare Provider Details

I. General information

NPI: 1760610992
Provider Name (Legal Business Name): KATHRYN COURY CONNOR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN JANINE COURY DDS

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 01/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E SUMMIT AVE STE C
WALES WI
53183-9664
US

IV. Provider business mailing address

300 E SUMMIT AVE STE C
WALES WI
53183-9664
US

V. Phone/Fax

Practice location:
  • Phone: 262-201-4718
  • Fax:
Mailing address:
  • Phone: 262-201-4718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6028
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6798
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: