Provider Demographics
NPI:1669685046
Name:CONNOLLY, SEAN PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PAUL
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:8208 PENMAN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6963
Mailing Address - Country:US
Mailing Address - Phone:704-910-9465
Mailing Address - Fax:
Practice Address - Street 1:11440 CARMEL COMMONS BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5308
Practice Address - Country:US
Practice Address - Phone:704-541-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH34611223X0400X
MA200881223X0400X
CA467711223X0400X
NC84291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics