Provider Demographics
NPI:1184154684
Name:CONNOLLY, ASHLEY NICOLE (RDH)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:CONNOLLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:29 STONEYBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0553
Mailing Address - Country:US
Mailing Address - Phone:207-214-3145
Mailing Address - Fax:
Practice Address - Street 1:29 STONEYBROOK WAY
Practice Address - Street 2:
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401-0553
Practice Address - Country:US
Practice Address - Phone:207-214-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-16
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH4068124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEDH4068OtherREGISTERED DENTAL HYGIENEST, MAINE STATE DENTAL BOARD