Provider Demographics
NPI:1861687808
Name:CONNELLY DENTISTRY PC
Entity Type:Organization
Organization Name:CONNELLY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-669-1251
Mailing Address - Street 1:4 ELLIOT WAY
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103
Mailing Address - Country:US
Mailing Address - Phone:603-669-1251
Mailing Address - Fax:603-669-1360
Practice Address - Street 1:4 ELLIOT WAY
Practice Address - Street 2:SUITE 306
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103
Practice Address - Country:US
Practice Address - Phone:603-669-1251
Practice Address - Fax:603-669-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH035981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty