Provider Demographics
NPI:1659420370
Name:CONNOLLY, STEVEN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EXECUTIVE WOODS CT
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2016
Mailing Address - Country:US
Mailing Address - Phone:618-234-5600
Mailing Address - Fax:618-234-5891
Practice Address - Street 1:1 EXECUTIVE WOODS CT
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2016
Practice Address - Country:US
Practice Address - Phone:618-234-5600
Practice Address - Fax:618-234-5891
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist