Provider Demographics
NPI:1497029722
Name:CONNELLEY AND HIGGINS DMD
Entity Type:Organization
Organization Name:CONNELLEY AND HIGGINS DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONNELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-349-5125
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:SALYERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41465-0069
Mailing Address - Country:US
Mailing Address - Phone:606-349-5125
Mailing Address - Fax:606-349-5317
Practice Address - Street 1:761 PARKWAY DRIVE
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-9740
Practice Address - Country:US
Practice Address - Phone:606-349-5125
Practice Address - Fax:606-349-5317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60050788Medicaid