Provider Demographics
NPI:1609483312
Name:CONNALLY, ERIN N (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:N
Last Name:CONNALLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14830 CHOATE CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-9105
Mailing Address - Country:US
Mailing Address - Phone:704-588-4300
Mailing Address - Fax:
Practice Address - Street 1:14830 CHOATE CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-9105
Practice Address - Country:US
Practice Address - Phone:704-588-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60097424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist