Provider Demographics
NPI:1972679975
Name:CONNOLLY, JOSHUA MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:MICHAEL
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 1:399 8TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4230
Mailing Address - Country:US
Mailing Address - Phone:858-922-7001
Mailing Address - Fax:
Practice Address - Street 1:6588 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-5122
Practice Address - Country:US
Practice Address - Phone:505-326-6800
Practice Address - Fax:505-326-5809
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53987122300000X
NMDD2877122300000X
TN8897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist