Provider Demographics
NPI:1720142839
Name:CONNELLY, MICHAEL JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 VETERANS RD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4106
Mailing Address - Country:US
Mailing Address - Phone:914-962-5566
Mailing Address - Fax:914-962-6010
Practice Address - Street 1:206 VETERANS RD
Practice Address - Street 2:SUITE #5
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4106
Practice Address - Country:US
Practice Address - Phone:914-962-5566
Practice Address - Fax:914-962-6010
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0499651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics