Provider Demographics
NPI:1760584387
Name:CONNOLLY, DENNIS M (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:M
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 O ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2580
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:3910 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4783
Practice Address - Country:US
Practice Address - Phone:402-434-7383
Practice Address - Fax:402-434-7382
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13830208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01764OtherBCBS
NE1068OtherMIDLAND'S CHOICE
NE01764OtherBCBS
087304Medicare PIN