Provider Demographics
NPI:1346254794
Name:CONNELLY, THOMAS PATRICK (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:PATRICK
Last Name:CONNELLY
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 1:4 ELLIOT WAY STE 306
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3557
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:03103-3547
Practice Address - Country:US
Practice Address - Phone:603-669-1251
Practice Address - Fax:603-669-1360
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN029091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice