Provider Demographics
NPI:1265694327
Name:DONALD PAUL CONNOLLY
Entity type:Organization
Organization Name:DONALD PAUL CONNOLLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-722-5595
Mailing Address - Street 1:386 S GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3007
Mailing Address - Country:US
Mailing Address - Phone:831-722-5595
Mailing Address - Fax:
Practice Address - Street 1:386 S GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3007
Practice Address - Country:US
Practice Address - Phone:831-722-5595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty