Shane Connor, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

6802 Issued in WI

Practice address

1111 Delafield St
Suite 222
Waukesha, WI 53188-3417

Phone

(262) 547-8665

Fax

(262) 547-8685

NPI assigned

Apr 14, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Maxillofacial Surgery

Education

Marquette University School of Dentistry, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oral and Maxillofacial Surgery Associates of Waukesha, LTDGroup PAC ID 0244267227, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oral and Maxillofacial Surgery Associates of Waukesha, LTD.

  • Oral and Maxillofacial Surgery (Dentist)
  • Waukesha, WI
  • NPI 1235247834
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436486400000",
    "number": "1285877654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 DELAFIELD ST",
            "address_2": "SUITE 222",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883417",
            "telephone_number": "262-547-8665",
            "fax_number": "262-547-8685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 DELAFIELD ST",
            "address_2": "SUITE 222",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883417",
            "telephone_number": "262-547-8665",
            "fax_number": "262-547-8685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOR",
        "first_name": "SHANE",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-14",
        "last_updated": "2015-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "6802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan M Congdon, MS DVM DACVA
• James F Connelly, M.D.
• Ashley E Conner, APNP
• Kevin James Connor, D.D.S., M.D.
• Michael Scott Connor, D.D.S., M.D.
• Brett Connors, DPT
• Elizabeth Laura Connors, MSN, CNM
• Tajuan Conway, CSAC
• Melissa Cook
• Kelly Jo Cooke, DO

• Oral and Maxillofacial Surgery (Dentist) in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.