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General NPI Number Information
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NPI Number | 1508988387
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Entity Type | Individual
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Provider Name | DONALD PAUL CONNOLLY I D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 824 MISSION ST
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City | SANTA CRUZ
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State | CA
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Zip | 95060-3681
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Country | US
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Telephone | 831-426-1056
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Fax | 831-426-9447
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Provider Business Mailing Address
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Address Line | 1525 VALENCIA RD
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City | APTOS
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State | CA
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Zip | 95003-9782
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Country | US
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Telephone | 831-688-1967
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 24283
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License Number State | CA
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