Provider Demographics
NPI:1245446004
Name:CONNOLLY, JAMES JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOHN
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-9680
Mailing Address - Country:US
Mailing Address - Phone:724-929-4100
Mailing Address - Fax:
Practice Address - Street 1:514 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-9680
Practice Address - Country:US
Practice Address - Phone:724-929-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSL0216631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice