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General NPI Number Information
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NPI Number | 1730341884
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Entity Type | Organization
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Legal Business Name | DONALD PAUL CONNOLLY DDS
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 9059 SOQUEL DR STE D
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City | APTOS
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State | CA
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Zip | 95003-4067
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Country | US
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Telephone | 831-688-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 9059 SOQUEL DR STE D
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City | APTOS
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State | CA
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Zip | 95003-4067
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Country | US
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Telephone | 831-688-8112
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST/OWNER
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Name | DONALD PAUL CONNOLLY
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Credential | DDS
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Telephone | 831-688-8112
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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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