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General NPI Number Information
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NPI Number | 1467659110
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Entity Type | Organization
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Legal Business Name | STEVEN CONNOLLY, DMD, PC
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 EXECUTIVE WOODS CT
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City | SWANSEA
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State | IL
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Zip | 62226-2016
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Country | US
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Telephone | 618-234-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 1 EXECUTIVE WOODS CT
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City | SWANSEA
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State | IL
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Zip | 62226-2016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN M CONNOLLY
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Credential | D.M.D.
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Telephone | 618-234-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | IL
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