Provider Demographics
NPI:1285877654
Name:CONNOR, SHANE (DDS, MD)
Entity type:Individual
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First Name:SHANE
Middle Name:
Last Name:CONNOR
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Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-547-8665
Mailing Address - Fax:262-547-8685
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 222
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-547-8665
Practice Address - Fax:262-547-8685
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2015-07-10
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Provider Licenses
StateLicense IDTaxonomies
WI68021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery