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General NPI Number Information
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NPI Number | 1487468393
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Entity Type | Individual
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Provider Name | WANDY CONNOLLY DMD
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Gender | Female
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 1307 W MAIN ST STE A
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City | GUN BARREL CITY
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State | TX
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Zip | 75156-5405
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Country | US
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Telephone | 903-340-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 902 ROLLING DR
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City | ATHENS
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State | TX
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Zip | 75751-2944
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Country | US
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Telephone | 903-681-7730
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 42004
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License Number State | TX
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