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NPI Code Detail

MEDICARE: DR. CAROLINE CONNOLLY DMD

MEDICARE:  DR. CAROLINE  CONNOLLY  DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist019025865IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922137546
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROLINE CONNOLLY DMD
Provider Business Mailing Address
First Line : 7656 PLUMMER BUSINESS DR
Second Line :
City : TROY
State : IL
Zip : 62294-7604
Country : US
Telephone Number : 618-667-6650
Fax Number : 618-667-6615
Provider Business Practice Location Address
First Line : 7656 PLUMMER BUSINESS DR
Second Line :
City : TROY
State : IL
Zip : 62294-7604
Country : US
Telephone Number : 618-667-6650
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2007
Last Update Date : 03/26/2025

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Directions to “ DR. CAROLINE CONNOLLY DMD” Practice Location

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