Provider Demographics
NPI:1508988387
Name:CONNOLLY, DONALD PAUL I (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:PAUL
Last Name:CONNOLLY
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 VALENCIA RD
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-9782
Mailing Address - Country:US
Mailing Address - Phone:831-688-1967
Mailing Address - Fax:
Practice Address - Street 1:824 MISSION ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3681
Practice Address - Country:US
Practice Address - Phone:831-426-1056
Practice Address - Fax:831-426-9447
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics